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( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvirorimental, Inc. Date 0 a e�Page Of <br /> ra ti F-5 411k <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467.1006-Fax(209)467-1118 <br /> ClientPu Project Manager <br /> S [�1 � +-He Nests Required <br /> Phonq Num er <br /> 1/b7 l00�2 <br /> Samplers: (Si nature) Invoice: <br /> Project Name 4 �� �a AGE <br /> Client ❑ <br /> Sample Location Sample Type �l <br /> Number Descri tion Date Time Water Solid No. of as <br /> Comp. Grab. Air ContS. <br /> 56947 <br /> 1,/Vlop I I q 7 <br /> Ro lwve <br /> II Ir tr ff <br /> `' 5fi945�-a <br /> 1 1 1 0 ✓ j .. <br /> W 1�� a' F' f3 tt 1 `�j ✓ ✓ ,✓ i.. 5fi 94'9 `a <br /> it <br /> 1100 <br /> 11do V/ <br /> �� �' ►. t #� f t �f13�' ,/ ✓ ✓ .�5,69�52+ <br /> i . <br /> 101 ✓ ✓ 56953- <br /> e in a s a y: ignature) Received y: (Signature) <br /> - ue;elTime <br /> Relinquished by: (Signature) Received b Si <br /> Y� (Signature)nature} DatelTime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis; (Signature) Oale(Fime <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Data Time <br /> I - -) � � / / j S; <br /> Method of Shipment: t Laboratory Pmmav <br /> WOK VOAS I Q&G I I',jCTAl S THFR <br /> Special Instructions: ICF/0_ _ t �r-nW-SION — I hereby authorize the performance of the above indicated work. <br /> � ii._ ,,,i.,,l�f'.i.•i_i�f j.''if.,�'�N W......., C113'jlr.i�f�fiJ__ },J/�� � ....rte <br />