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[ _ Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvit-onmental, 1110 1-4),C,f-1 Dace y da Page 3 �3 <br /> 4005 Norlh Wilson Wny Slocklon Calilornra 85205 (209)467 1006 Fax(209)467 1118 <br /> C(ient Project Manager <br /> ___ �� � �--_ __�-�'!I„� ��1� ✓` Tests Required <br /> phone Number <br /> Samplers (Signature) � Invoice. <br /> q <br /> Project Name �lq f f AGE <br /> Cbent ❑ <br /> Sample Location Date Time Sample Type. Soil No of <br /> Number Doscrlption Water Air Conts /� Notes <br /> Comp Orab h <br /> I ` <br /> `3C00 X r <br /> _ 1 31> -� ,. �c, X _ 5� x 41678 <br /> -4 L 41679 <br /> ! <br /> �ar g oo c.�e�l -co !":x S` �' _ X 41680 <br /> -1115�1c S k >< X 4 16 8 j <br /> t <br /> M d (org lure) ecarve�byISIgnalure <br /> OalelTlme <br /> blzg1 <br /> u ie (Srgnalwe} Reeelved by (5rgnalure) <br /> r)rtslflme <br /> r <br /> liet,nyuithstd by (Slgneluro) Received by Mobile Laboratory lot field anely016 (Signature) rr Date/Time <br /> l ititielthed by (Signalore) tints/ilrne Received for Laboralory by Dalefftno <br /> 41e1hod of Shipment r rLa�bota:lory NameGpectei h+eirvellone hereby aulhorize the performance Of the above indiealed wrolk <br />