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i 1LoDI1 0 1 <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvtronmenta , Inc Date Ll 'I 7 - Go Page of� <br /> 4005 North Wilson Way Stockton Calilornia 95205 (209)467 1006 Fax(209)467 1118 <br /> Client 1 Project Manager <br /> C- Tests Required <br /> _ Phone Number <br /> Z (D9 VO o <br /> Samplers (Signature) 4` clq Invoice <br /> Project Namet t t I A <br /> .�1 Client ❑ <br /> Sample Location Sample Type �� <br /> Number Description � QU <br /> Date Time Water Solid Nos Notes <br /> � <br /> Comp Grab Air nt <br /> CcOL-w Ict <br /> V I - CA AV 11 <br /> - �00 1 <br /> e in ui� <br /> (Sig uie) eceive y (Signature) Date ima <br /> Relinquished by (Signature) Received by (Signature) Dat (rime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) DAVOT Received for Laboratory by Dateftime <br /> 04)/60 lit-L <br /> Method of Shipment Laboralory Name <br /> V r�IC �r nG <br /> Special Instructions r I hereby authorize the performance of the above indicated work <br /> v �5� 4� 0 �or ���� - !� 7 x 5 h.-Z do <br /> cD,6 —Z– , <br />