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�Ml M M M M M M !• I• III <br /> Advanced CHAIN OF CUSTODY ECORD <br /> GeoEnvironmental, Inc. Date OR-o`)-g-1 Page of <br /> of Norihent Califomia <br /> 1603 West March Lane, Suite A-Stockton,California-95207-(209)956-0264-Fax(209)956-0700 a A6 E 3Da <br /> Project Manager <br /> Client (-14"l C Ht r Tests Required <br /> Phone Number <br /> o <br /> q56- 0 <br /> Samplers: (Signature) Invoice: <br /> AGE <br /> Project Name Client p i <br /> FTG C 41 G t ran .. <br /> Sample Type <br /> Sample Location Solid No. of �,�srts� <br /> 80559 '` <br /> Number Description Date Time Water <br /> Camp. Grab. AIC ContS. , <br /> rn <br /> WR 5 <br /> P <br /> r kt <br /> P4 <br /> 7c) <br /> n <br /> ^ af 2o-Pzg4O r ;•ir ,.:. ..! <br /> iris <br /> py ,3O •• 3o-flee O X t, � _80_5AZ <br /> r:. ti :80.563'1- <br /> 80 5-A-4 <br /> 3.1805G4 <br /> r tf 80585. , <br /> r <br /> equisay: Signatre Received TgDatelTime <br /> % )A0 -ot- q <br /> r.:,m <br /> Relinquished by: (Signature) Received b : (Signpate rime <br /> <Jmature) 10--30 <br /> O: q q-1- <br /> Relinquished by: (Signature) Re ived by Mobile Laboratory for field analysis: (Signature) Dateff <br /> i " <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: DatelTime <br /> Method of Shipment: CM UA 1%C t�w Laboratory Name <br /> C CA OWAW� <br /> Special Instructions' V AAS I hereby autho ize the performance of the above Indicated work. <br /> ON UALS�OTFI , <br /> FRURANUN <br /> GOOD CONDITION ✓ APPROPRIATE - <br /> HEAD SPACE ABSENT CONTAINERS <br />