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Advanced 0 <br /> CHAIN OF CUSTODY RECORD <br /> —_= GeoEnvir r- <br /> =- onmenta�, Inc. <br /> Date b'13"�7 Page �� f <br /> of Nnrrlrerrr Crrltjrrntrrr a <br /> 1803 West March Lane Suite A Stockton, California 95207 (209)956-0264 Fax(209)956-0700 <br /> ! Client G O Protect Manager <br /> 14 <br /> Bob M a li- 1 Tests Required <br /> Phone Number <br /> �oq) q �-6-0,1 6 <br /> Samplers (Signature) ,° N` s` Invoice <br /> r <br /> Protect Name a lN� U'u ,��"k �� �� AGE ❑ <br /> q�o`�a Client ❑ <br /> ' Sample Location Sample Type U moo` <br /> Number Description Date Time Water Air Solid C n st Notes <br /> Comp Grab .rte <br /> PIO-33g -q <br /> b -8 5` I a:;Lo X � <br /> 1 x x X `SM.lr l <br /> 38 C 1 <br /> ' 0.4 0 X l 28E.7G 2 <br /> 10 L4 1 i-, 3D X 1 X X xl 2C;1--,7FL <br /> PII - ;�aB l9'30X_ � x X X �1,t=,7F n <br /> Pit - 3"9f3 , <br /> P l l - 53 1 6 Z I X 'S,E7F7 <br /> e inqu s e y ,gnature ece,va <br /> y ignetur r _ _5 Date ime <br /> J � <br /> � Re r qulshed by ,gnstur -x� <br /> rvad 6'13-95tQ;00 <br /> (p—f Cf-�5 Ra� gnatureJ <br /> Dale/Time, <br /> etlrtqurshed by (Slgnelure) Aec d by Mobile Laboratory for field analysis (Signature) <br /> Dale/Time <br /> Dispatched by (Signature) DatofI Ime Rocalved for Laboratory by <br /> DatelTime <br /> Method of Shipment <br /> Laboratory Name <br /> Special Instructions <br /> Midw�s�' I�ba,���er) es <br /> ! hereby authorize the performance of the above Indicated work <br />