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� � � � � f1• � � � t� I� � filifliii� wtt� ,� <br /> Advanced CHAIN OF CUSTODOECORD <br /> Date k!"i 5—OPPage 1 of <br /> - „ GeoEnviron mental, Inc. ,_raLE5�t3 <br /> 4005 North Wilson Way-Stockton,Califomia-95205-(209)467-1006-Fax(209)467-1118 <br /> Client G +t QS + Project Manager Tests Required <br /> Phone Number <br /> 7 <br /> Samplers: (Signature) 4, Invoice: <br /> \C� AGE rK <br /> Project Name �., MAz � J. y Client Q <br /> Sample T e Z- S,�' <br /> Sample Location No. of <br /> Date Time Water Solid Notes <br /> Number Description Comp. Grab, Air Conts. V^ <br /> MW to/r 2 5a c I''1 VV -`o I�-��-t� I O Z a -3 X 56437 t't ) <br /> P'IV 7/ Iz)so0 Irl w-� Iz-I '41 1Zvv 3 �( x 56438 { <br /> / — <br /> 56439 <br /> x x 56440 <br /> m 3 x <br /> w'i4 / Izis[3b �f�,�_ � � Iz-rs=-oo I d•S� .�'� � X 56441 <br /> � ^ . <br /> ,z <br /> . J- xT 5 X � _ 56442 � <br /> wig li'zi-roo �z rs-�� I�1 .� <br /> $` r e Y. ( ignatu{e Receivedy: (Signature) [� '_60 ima <br /> Reli quished by: (Signature) Received by: (Signature) <br /> 56443 <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Date[Time <br /> p_odrL, Lx �� � •'b� <br /> Method of Shipment: ` Laboratory Name <br /> Speo+af instructions; �q {t,f Tri r I hereby authori a the performance of'the above indicated work. <br /> _'i.rlA!IriqJ'i,.'•�.._.._a <br />