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ri �_ �tl ftftftftftf� ftp ftp i � � � � ,• � � � �� i• <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date -N 4Page of <br /> ^` of Northern Calrforma <br /> 1803 West March Lane Suite A Stockton, California-95207-(209)956-0264-Fax(209)956-0700 <br /> Clientt , Project Manager— <br /> d�'h I ;m G u Ca r Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> Project Name �r4 �lw AGE <br /> Client ❑ <br /> i , <br /> Sample Location Date Time Sample Type Solid No of <br /> Number Description ComWater Air Cents Notes <br /> wed - -lq?7 5 . t '�VJA <br /> W -3 1 ,'a0 ` <br /> - -71 3:Lq <br /> e in uis e y (Sig ture) ecerved by (Signature) Date/Time <br /> Relinquished by (Signature) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Timeceived to Laborat or b Date/Time <br /> S'-/E_-�? c4-,3c) <br /> Method of Shipment Cabo atory Name <br /> Special tn5trU6tL0n5 I hereby authorize the performance of the above rnd cated work <br />