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i • i <br /> Advanced c CHAIN OF CUSTODY RECORD <br /> _ Ca b� � _ s� <br /> Dat Page <br /> GeoEnvrixonmental, Inch 9 �� � <br /> CL �.� 4005 North Wilson Way-Stockton Callfomia 95205 (209 467 1006 Fax(209)467 Ilia <br /> ClientProject Manager <br /> p C 1 _ Tests Required <br /> Phone Number <br /> m Samplers (Signature) (j� / Invoice <br /> o Protect Name G { AGE Pq <br /> Client ❑ <br /> r- Sample Location Sample Type No of <br /> Number Description Date Time Water Air Solid Cants Nates <br /> 0 -� Comp arab <br /> 'J�&-rS coo I. A �-i� ,� ?� k I I <br /> 40589 <br /> I <br /> Co <br /> 1` <br /> N <br /> a ML(Sig..eu6m)e) ece ve by -IM <br /> Date/Time <br /> C 64/0-0 <br /> RelrnqReceived Da eflmel y (Slgnatvtet <br /> a� <br /> 41 <br /> a <br /> .-r <br /> ro Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Tlme <br /> a <br /> s - <br /> 'i Dispatched by (Signature) Ualellirne ]Received lot Laboratory by Dateflime <br /> a� <br /> CL method o <br /> caShipment Laboratory !Jame <br /> - c-I` �, <br /> U <br /> U L y n/+Ir rr <br /> Special anriructlone lrve h7^^ray —r,-, I 1 hereby suthonxe the perlormance of the above Indicated wotk <br /> m i til _ ..,.._...�� .�_� Ir' 1 i I'rl �/ L. <br /> 1 �U X111111-! <br /> e1 <br />