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S <br /> y <br /> Advanced CHAIN OF CUSTODY RECORD <br /> _ - GeoEnvii onmental, Inc Date Z J -`�Z Page _ of <br /> 837 Shaw Road-Stockton, Californra- 95215- (209) 467-1006 -Fax(209)467-1118 <br /> z <br /> Client Project Manager <br /> f✓ i�, es ► n Tests Required <br /> Phone Number <br /> a0l - 9U7 - 100(,- <br /> Samplers, <br /> p0(:Samplers (Signature) ru Invoice <br /> Project Namerr} AGE 2gF 16 C,± L�hG.�s�3 n � V� Client ❑ <br /> Sample Location Sam o <br /> ype Nof <br /> Date Time Water Solid ti Nates <br /> Number Description comp Grab Air Conts `— <br /> ,w►3 , J tz� , I s)o <br /> Aqqu,.he u a ,y ( rgnature ece,ve y rgnature Datel7ime <br /> !73)y (Signature) Rece,ved by (Signature) DatelTrme <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Frme <br /> I <br /> w <br /> Dispatched by (Signature) Date[Time Received for Laborator br"' teff-I <br /> Method of Shipment Laboratory Name <br /> _ Cct v L/e-,-ix, � L Mt (Cir"o be- <br /> Special instrurtrons qr} f`1St3 1 I hereby authorize the perfo mance of the above indicated work <br /> tt ' vZ/^ <br /> .Lf.W�t hla�iA11i1 tYa�brJ�,� 13 <br />