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CHAIN OF CUSTODY RECORD <br /> ,? Advanced Date ` I Page of <br /> --- <br /> GeoEnviron mental, Inc. <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 AK <br /> Client �j- Project Manager keA `� Tests Required <br /> °W -e r f p t h <br /> Phone Number <br /> 7- NO <br /> Samplers: (Sign ture) Invoice: <br /> X (( ° AGE <br /> Project Name ,� �V <br /> 'i Client ❑ <br /> • sample Type � <br /> Sample Location No <br /> Date Time Water Solid . of ti ' 94788 <br /> . <br /> Number Description comp. arab• Air Conts. r <br /> 94789 <br /> C(--t 9479Q <br /> MW 7 w �a X ' <br /> 9479.1 <br /> 94792 <br /> 94793 <br /> J �t+vim.( -(c!- `� y, qo W X r . <br /> X 94794 ; <br /> X <br /> Refin �s e y: ignab a ecei a y: ignatu a Date me <br /> fT <br /> I'(? <br /> R li quished by: (Si%nature) d by: (Signatur r Da1elTime <br /> DatetTime <br /> Relinquished by: (Signature) Rec ed by Mobile Lab glory for field analysis:(Signature) <br /> Dale/71me <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: <br /> Method of Shipment: Laboratory Name <br /> J <br /> Special instructions: I hereby authorize the pefformanl6e of the above Indicated work. <br /> VOIS I O&G 1+MLS OND" VA4� .4t (.ME nVAll <br /> � <br /> (31001 CONDITIONyAMOPIPME <br /> (;E AaSFiiT COHTAI <br />