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ti11V4 <br /> lel)J�, Advanced ! <br /> CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. r L� <br /> V ~�' of Nor7hem 011ifor ma Date 6 3'Q 1 Page —�— Qt---L_ <br /> 1803 West March Lane,Suile A-Slocklon, California 95207-(2W)9,%0264 Fax(209)956-0700 <br /> Client Jrp Project Manager <br /> Do <br /> McIvri, Tests Required <br /> Phone Number <br /> 70q) gsb -D,�b <br /> Samplers (Signature) <br /> Invoice. <br /> Project Name AGI•= ❑ <br /> � Client <br /> Sample Location Sample Type -v 0 <br /> Number Description- Date Time Water Solid NO of fl `Z` <br /> Comp TX <br /> Air t2zx <br /> ay Qt'+� Notes <br /> X 2wF.,8, <br /> MIN-tg16- r�-`l5 �-o; D X Z 25E78:2 <br /> -------------- <br /> r� <br /> is <br /> e inqurs re !Ubyj0(gn8Tufe) <br /> gnalure <br /> 7/ acorvo y ipnnluro <br /> �q,{� i J f (�U a / Oele/Tlme <br /> Relinquishedgnnturc) <br /> Received by (Signature) <br /> Uele/Tlma <br /> Rohnquishod <br /> Rocewed by Mobde Leboratory for hold anatysls (Signature) <br /> DatalTlm• <br /> Diepetched by (Signature) Oa1o11ime <br /> Rocerved for Laboratory by <br /> DateMme <br /> Method of Shipment <br /> Laboratory Name }} J � <br /> Special Instructions r d W•37 L�q&00 ^I ori t 5 <br /> 1 hereby authorize the performance of the above Indicated work <br /> r <br />