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f Advanced J <br /> CHAIN OF CUSTODY RECORD <br /> " GeoEnvuonmental Inc. <br /> Date l b ` <br /> 2 953 �- <br /> Z� L' _ Page 3 <br /> � of <br /> 837 Shaw Road-Stockton, California-95215- {209}467-1006- Fax (209)467-1118 <br /> Client WOW <br /> Prol ana er <br /> Tests Required <br /> PhgAe N ber <br /> Sa . (Signature) <br /> Project Nam Invoice: <br /> AGE <br /> Location Sampe Type <br /> Sample Client ❑ <br /> lO <br /> Number Date Time No, of b <br /> Description Water Solid <br /> Comp. Grab. Alr Conts. Notes <br /> Mio <br /> 68115 Ar F <br /> V 'o&c ALS OTH <br /> 10EW LX-` RESER V TION <br /> T <br /> HTEA WP A-2-�7V ONTAIN €�S <br /> e Fnqu, y ,gnatu <br /> ecerve y: rgnature <br /> D tell ime <br /> Relinquished by. (Signature) Received by: (Signature <br /> ] <br /> Datum <br /> me <br /> Retinquishad by: (Signature) Received by Mobile Laboratory for field analysis;(Signature) <br /> Dispatched by: (Signature) r1 Date/Time <br /> Date/Time c ivJed for Labe at by: / 4 <br /> V1 - y vijl/}1 - $/2�' Q 11 Date/Time 1r+,� <br /> Method of Shipment: � . <br /> Laboratory Name <br /> Special instructions: rfe <br /> I hereby out a the pe form of the above indicated work. <br /> A. <br />