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' Advanced CHAIN OF CUSTODY#CORD , .-Q' <br /> _ � <br /> - GeoEnvironmental, Inc. Date _(-� Page °fes <br /> of Northern California <br /> 1803 West March Lane,Suite A-Stockton,California-95207-(209)956.0264-Fax(209)9560700 064 Qg <br /> Client Q e _ Project Manager <br /> — , - mgdif C/A �evf- Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> AGE E <br /> Project Name S Client <br /> Sample Location Sample Type Solid NO °t Notes ' <br /> Date Time Water <br /> Number Description comp Grab Air Conts — <br /> r <br /> MW - 13 <br /> 70w-d-1-3 !U-6-17 3114 ( Y, x <br /> ;� N r� 76245 <br /> -17 <br /> E <br /> a <br /> v <br /> 1 <br /> Relinquished y ignature ec v y igna e _ <br /> 4,f1 q Z {� <br /> Relinquished by (Signature) Aqcpifed by (Sign Lure) Date/Time <br /> Relinquished by (Signature),- Received by Mobile Laboratory for field analyals Date/time <br /> a <br /> Dispatched by (Signature) > °i _ , Dale/Tgme ----[Rec d for Laboratory by Date[Time <br /> 1 <br /> Method of ShipmentU //�1 Q� LL�� /Q fg/ Laboratory Name <br /> ." 6-ve� <br /> j _ 1 hereby authorize the perform nce of It above indicated wo <br /> Specie! insEructions l � �}p� ,�r� 1; �� ,�,�/J <br /> pIGUY.J yf'JC� <br /> , I 1 <br /> 9 — <br />