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- ' <br /> =77 7. a-"7 71 �-] <br /> Advanced CHAIN OF CUSTODY RECORD <br /> Date 4f— Page ---L of <br /> - - " GeoEnvironmental, Inc. Il <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1119 <br /> Client a r- Av Project Manager Tests Required <br /> Phone NV tuber . <br /> Samplers: (Signature) < Invoice: <br /> AGE <br /> Project Name Client E <br /> Q me E] <br /> Sample Type <br /> Sample Location Date Time Water Solid No. of Notes <br /> Number Description comp, Grab. Air Conts. <br /> � s <br /> 53- a E- - 43324 <br /> � k <br /> xJ 43325 <br /> t <br /> gn t e Receive y: (Signature) Datefri e <br /> v. <br /> ign t e) Received by: (Signature) Dat !Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) y Date/Time <br /> J <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Date/Time <br /> 4 <br /> Maod of Shipment: r-A <br /> Laboratory Name <br /> r CC <br /> Special Instructions: C ' I here6y authorize a performance of the above indicated work. <br /> s'WTO 11 <br /> r�Jr11Lt � Ars <br /> L. Y c <br />