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Mr a 0 <br /> Advanced CHAIN OF CUSTODY RECORD <br /> �-7 Dated: ab Page of <br /> GeoErivironmental, Inc. <br /> CL <br /> 4005 North Wilson Way Stockton California-95205-(209)467 1006 Fax(209)467-111 a <br /> Client —F:�-1 Project Manager Tests Required <br /> LURA <br /> Phone Number v <br /> LC-111A (0-71006 <br /> - <br /> N Samplers' (Signature) ,yJL <br /> Invoice. <br /> /` � "7 W` AGE S <br /> o Project Name r Ag �� �-�{�e- rz) n I Client E] <br /> Client <br /> Sample Location Sample Type No of f Notes <br /> p Date Time Water Solid <br /> Number Description Comp Orab AirGt)t1t5 <br /> k _ 5 x k x x _ 3900 <br /> 39002 <br /> m <br /> CID <br /> `' '' # _ 9 x _ 39003 <br /> �W It %\ x X 39004 <br /> O• o <br /> tit ;K <br /> I <br /> 39006 <br /> r r <br /> t <br /> 1-4 e v y ignaiure ec vsy lure DeIeJT me <br /> DatalTlma <br /> a ed by (Signature) Received by (Signature) <br /> m <br /> DalalTime <br /> Q Ttetinquished by (Signature) Received by Mobile Laboratory for field an (Signature) <br /> _ sd AT <br /> ar Dispatched b Dea ve a ownrle/Tsme Tie' Rry,� pale ms <br /> � P Y (Si9natute) i I 141I <br /> E - <br /> m La oratory Name <br /> c] Method of Shipment /+ <br /> 2 <br /> Special Instructions r F�� i. ,} . l ot1��+l�f) i hereby em(horize the performance of the above indicated work <br /> T14e++se 5en bct c k >xw -3 Cie � �, <br />