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• 4r <br /> [� Advanced CHAIN OF CUSTODY RECORD <br /> Date ` Page of—�— <br /> GeoEnvironmental, Inc. <br /> 4005 North Wilson Way-Stockton Cahfomia 95205-(209)467-1006-Fax(209)467 1118 1604 <br /> r 3 <br /> ClientbL–cProtect Manager <br /> Lt, -� Ife-U! f� &44�eTests Required <br /> 0h) q Phone Number '' ` <br /> 4 �,,Vve <br /> Samplers (Signature) ,r� Invoice <br /> Project Name AGE <br /> Q� Client <br /> � � t <br /> Sample Location Sample Type Date Time Water Solid No of { 86665 <br /> Number Description Comp crab Air Conts r + <br /> 86666 <br /> M &V- f 3 —/0 6 , 16 X I K t� 86667 <br /> l , <br /> 1/ 7 _ # 86669 <br /> f � Z -10-(y _ 61C <br /> 0-131qd-fy hdh <br /> ti <br /> 21 N X <br /> I' is e y ( ignat e) e _ y (Si n Lure _! —Qg ate17 } <br /> 3 a jc(�Q <br /> 5f� <br /> Relinquished by (Signature) eived by (St nature) 6 <br /> 86676 _ <br /> Relinquished by (Signature) Received by Mobile Laboratory for held analysis (Signature) ) r, <br /> t <br /> 86671 <br /> Dispatched by (Signature) Date/Time Received for Laboratory by t <br /> Method of Shipment Laboratory Name <br /> ° Y, � <br /> Special instructions WAS ON METALI� OTHER' I hereby authorize the periorman a of the above indicated work <br /> rr v UOIq IYILI►t J VIrIGrI . <br /> GWi COMOITIOV._,,L APPROPRIATE <br />