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tf� ��� � � � � ftp � � � lfi• lfii ifi tlfi tlfiT�'.,'1,`I <br /> Advanced CHAIN OF CUSTODY ECORD <br /> GeoEnvironmental, Inc, Date 1 Page of <br /> of Nor-thern California <br /> 1803 West March Lane, Suite A-Stockton, California-95207-(209)956-0264-Fax(209)956-0700 <br /> Project Manager ; . <br /> _r lf' II ,r Tests Required <br /> Prhone Number <br /> Samplers: (Signature) Invoice: <br /> Project Name /�.�u� �i �fc,�c nf�I'j ,�' ;� / y `�� AGE �, ... <br /> v 1 u� 4 Client ❑; <br /> s o <br /> Q , <br /> Sample Location Sample Type No. of <br /> Number. Description Date Time Water Solid �� Notes. <br /> Comp. Grab. Air Conts. `, <br /> f1U1--6fy ;;P <br /> hw- zs - -q6 ;., Y <br /> .G <br /> Mw- 1/h - 3 ~c'6 1 ' �� V X <br /> 0w- 13/5 3- '16 ob N <br /> Re m�u�s a y: �gnatyr Recerve y: ignature DatelTime , <br /> elinquished by: (Signatu(e) Received by: (Signature) Dat /Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) Data/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by. DatelTims . <br /> Method of Shipment: Laboratory Name <br /> rI Mom <br /> Special Instructions: l hereby authorize the performance of the above indicated work. <br />