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W • 0 - <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmentaI Inc. <br /> � Date 5• -1$ -q ri—page 1•— of <br /> of Norrhent California <br /> 1803 West March Lane Suite A-Stocklon, California-95207 (209)956-0264 Fax(209)956-0700 13 <br /> Client <br /> L D Prgobct Manager <br /> Hitr dTests Required <br /> Phone Number <br /> (�vq) YS6 - o.-6L4 <br /> Samplers (Signature) Invoice <br /> Project Name &.Q wtl� j ) t c..7 ►� '� AGE [� <br /> � Client ElSample Location Sample Type it <br /> Number Description Date Time Water <br /> Air Solid Colts � Notes <br /> Com <br /> —p <br /> MW -Iq IS~ Iq -qui 5-th y r3.ov 2- X 526� 3 � <br /> / 13 - ISI <br /> Ew�l 5-18 q� 3� �, 2 x 52689 <br /> I <br /> Relinquished y (Signature <br /> ) � rve y ignature <br /> Jr'b�'f� Date/Time <br /> r -I�_gsll6�3� <br /> Relcnquished by (Signature) Rec ed by (Signature) <br /> Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) <br /> Date/Time <br /> Dispatched by (Signature) DatelTime Received for Laboratory by <br /> Date/Time <br /> Method of Shipment i � Laboratory Name <br /> M �cgx4 b" [ r <br /> Special Instructions NT <br /> �r,..r . Ci – I herebyauthorize the <br /> tr ��'�!lirwlE performance of the above indicated work <br /> �4Y�.�SI'AC��BSc`d�_..,,,o, Caa1� ccci✓ 5��LE �- tifyt�Y�. jl� <br /> -_ r <br />