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� �� w�■ r! wiwr ,w..r ori r � w.■ r.� tt�� Ilia♦ tllltttttl� twl��. � tl_ <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date -q0 Page _i— of� <br /> rf Norlheru Culrfijrrlrct <br /> 1803 West March Lane,Suite A-Stockton, California-95207 209 956-0264-Fax 209 856-0700 <br /> � � � } Sal AA6Z5, I5l <br /> ClientProject Manager <br /> Tests Required <br /> xzLA} M <br /> Phone Number <br /> Lgo C0 cr�4-a,�-6' <br /> Samplers: (Signature) Invoice: <br /> //yy��'' /,� AGE tK <br /> Project Name � k W Q �.(,k -►w[,���-CSI Client ❑ <br /> Type Typ <br /> Sample Location SampleNo. of <br /> Number Qescri tion Date Time Water Solid Notes <br /> p Comp. Grab. Air Conts. =' <br /> r es <br /> MW — 7—l 7—ct6 7-17-� 151110 Z_ 6`7 p 2 , ; <br /> e in urs ed y: (Srgnalur } Revprdy: ignp <br /> '7..)9, 4 DalerTime <br /> uc cJ /0:3 7-t 7-qiZlpq6, <br /> Relinquished by: (Signature) eived by: (Sip lure) Dataftime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) DateTime <br /> Dispatched by: (Signature) Dale/Time Received for Laboratory by: Date(rime <br /> Method of Shipment: 01 OvLaboratory Name <br /> �rN i 11 -�c�e2 i sG c Ca <br /> Special Instructions: nno� t��r{ �trn i hereby authorize the performance of the above indicated work. <br /> itff��' •X�'�' �J`�147 'liGl!'r1.S �1:(itil <br /> O <br />