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Advanced to CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental Inc. Date 9-P Page ---L of <br /> n/'Northei-a Cali%ryrto <br /> 1803 West March lane,Suite A-Stockton,California-95207-(209)956-0264-f=ax(209)956-0700 <br /> Client Project Manager <br /> Tests Required <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> Project Name AGE <br /> p /,( � ti�;W Client ❑ <br /> Sample Type <br /> Sample Location Date TimeWater Solid No. of / Notes <br /> Number Description Air Conts. <br /> Comp. Grab. <br /> Wi /1"P q1M �Z; o <br /> t-ut 2S ✓ - <br /> NW3 laf-5)-C�J;a '�t:3 D <br /> tSD <br /> elinquis a y:•(Signature) Received by: ( rgnature) pate ime <br /> & J 4� fo <br /> Relinquis ed y: (Signature) Recei {Si nature) /� te/Time <br /> T /`'r r // —/0 <br /> Relinquished by: (Signature) R ceive y Mobile tabor tory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: pate/Time <br /> Met of Ship;% - Laboratory Name <br /> S ecial Instructions: / I hereby authorize the performance of the above indicated work. <br />