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7-7 C:D F=- <br /> Advanced CHAIN OF CUSTODY�RECORD <br /> _ GeoEnvironmental, Inc. Date 0 1-7 Page 3— of 3-� <br /> of Northern CalifOlVia <br /> 1803 West March Lane,Suite A-Stockton, California-95207-(209)956-0264-Fax(209)956-0700 902-79 x n E aq a <br /> Client` Project Manager <br /> Tests Required <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> Project Name \\ AG <br /> Client ❑ <br /> Sample Type <br /> Sample Location Date Time Water Solid No. of Notes <br /> Number Description Air Conts, - <br /> Comp. Grab. <br /> Z3 4a Z'-] 5,,ri Ro c OfrA5 <br /> 2- Z� 5 cd P�o13Z 0Q£,n 2, <br /> - r D� <br /> v r 4- , c ' <br /> Ici <br /> e e y: �gnatureec a y: ignature7 Date/Time <br /> V <br /> Relinquished by: (Signature) ived by: (Sig Lure) DatelTim <br /> Relinquished b (Signature)q Y= l 9 ) Received by Mobile Laboratory for field analysis: (Signature) 'v�r} �•-�Q Vo} Dale[Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Date/Time <br /> Method of Shipment: Laboratory Name <br /> c,Crn 0/) <br /> 1 'Cts, <br /> Special Instructions: I hereby a^horize the performance of the above Indicated work. <br /> r <br />