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i �i i i i i i i � l• i i � i � �� � <br /> Advanced CHAIN OF CUSTODY RECORD <br /> I <br /> GeoEnvironmental, Inc. Date a13 -9 Page —J— of- <br /> '::, ref Nvrllrr•r1r Culifnr-nirr <br /> 1803 West March Lane,Suite A-Stockton, California-95207-(209)956-0264-Fax(209)956-0700 <br /> ClientPr <br /> C � C-�4 L ;O� --Project Manager Tests Required <br /> Phone Number <br /> Samplers: (Signature) j Invoice: <br /> AGE <br /> Project Name r <br /> Client ❑ <br /> ��� � <br /> Sample Location Date Time Solid No. of ��,<� i� Notes <br /> Water Sample Type <br /> Number Description comp. Grab. Air Cants. <br /> 3vaA <br /> -LY 101. ooY, ix <br /> t'ZAw,tx <br /> J 7 (^ r AJC/ <br /> AIX <br /> is ed y: (Signature) Received by: (Signature)Date/Time <br /> S Sr <br /> Relinquished by: (Signature) Received by: (Signature) DatelTime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Dale/Time <br /> Dispatched by: (Signature) Date/Time Rec �Ye for La ora �y: Date/Time <br /> 1147°� -a-� (� /o00 <br /> Method of Shipment: Laboratory Name <br /> Special instructions I hereby authorize the periorman Le of the above indicated work. <br />