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Advanced CHAIN OF CUSTODY RECORD <br /> z,co--�c1 <br /> --- ,. <br /> GeoEnvironmental, Inc. Date ` Page of A_ <br /> �--W <br /> 4005 North Wilson Way•Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> 1 21)9 Ella- <br /> Client <br /> y i; <br /> Project Manager <br /> Client j4 1, y t Tests Required <br /> 6-V V)q M C- <br /> Phone-Number f <br /> (zay) 467- rvoG �t <br /> Samplers: (Signature) Invoice: <br /> r I q �� AG E Qq <br /> Project Name �j-e W4 Client/� Client ❑ <br /> k <br /> Sample Type a <br /> Sample Location Date Time Water Solid No. of q� otes <br /> Number Description Air Conts. <br /> comp. Grab. <br /> P <br /> )0' ;3 }� <br /> e inquis e y { n re <br /> Received y: { rgnalure <br /> 1�4�4 15;?c7 <br /> etinquished by: (Signature) Received by: (Signature) DatelTime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) DalelTime <br /> Dispatched by: (Signature) Dale/Time Received or Laboratory by: DJateftime <br /> —VIA <br /> \ 17— <br /> Method <br /> ZMethod of Shipment: Laboratory Name <br /> cry '~ M I <br /> o u�r to � (n <br /> Special Instructions: P11ESrf1Tfo I hereby authorize the performance of the above Indicated work. <br /> GOOD CONDITION <br /> HEAD SPACE ASSENT <br /> _11100v CONTAI�fER <br /> c <br /> ��� 1 �.'C;t�,(1. �C?C�I F�I4t:` `.�`.Jr fit_ �%)•I�s•(�,� <br /> rararararr ti � � � � � � � � ttttttttttt■ � � s ttttttttttt■ � <br />