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Advanced CHAIN OF CUSTODY RECORD <br /> - GeoEnvironmental, Inc. x' O Date 3`0/-0 r page --L__ or J <br /> 4005 North Wilson Way Stockton,California-95205-(209)487-1008-Fax(209)487-1118 _ <br /> Client >P`G Project Manager <br /> Tests Required , <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> Project Name �C 1 f _ 9 AGFA--- <br /> C H' V r p is w Client ❑ <br /> Sample Location Samp a TypeNo ' <br /> Number Description Date Time comp <br /> Wat ar►ab Air Solid Conts \�D Notes <br /> Ci , <br /> 63 <br /> 63388 a <br />! Mw &T t �� -i s r 6338 <br /> i <br /> M\ - low �"" �/ 63390 X_ <br /> Relinquished (Signature) Tcetve by ignature <br /> j {]ate/Time <br /> Relinquished b •Si nature <br /> q y ( 9 ) Rec ved by (Signature) WAS O&G MEDALS Qm1a Date/Time <br /> e <br /> Relinquished by (Signature) oOD��� Data/Time <br /> PPROPRIAT <br /> Dispatched by (Signature) ipesi�LmeHh, Received for Laboratory b� Dateffime <br /> Method of Shipment t_abo ory Name <br /> lvo(�d <br /> Special Instructions I hereby authorize the performance of the above indicated work <br />