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U L �WW low) 14-1 lel U am t� <br /> Advanced CHAIN OF CUSTODY CORD <br /> I = GeoEnvironmental, Inc Date q -a 7 Page -- of <br /> 4005 North Wilson Way-Stockton,California 95205-(209)467 1006-Fax(209)467-1118 <br /> !N lsq MEE MIXt <br /> Project Manager Tests Required <br /> Client [ ef ( ��Inl C � [t�tihf `k iova011b�lt 1�,�Vrv1 � � 1�rb��✓1 <br /> E Phone Number <br /> Q-og ) 4 17 - 1006 <br /> Samplers (Signature) Invoice <br /> q� �,/ AGE <br /> Project Name G �} f V o K-t-t T r to�R 5 Top d"'✓"(l'1 �� `�' Client ❑� <br /> h <br /> Sample Location Sample Type No of ; '; � �� <br /> Date Time Water Solid �'Z` @ J PAZ_ aS��2� <br /> Number Description Air Conts ,` f; *a1R �r� R Gomp Grab d{.tlr:4+ � � ti, �# �'tsV <br /> 5 ~-S fl-r�-q �.�a X 1 , �. Y r"Ar~ <br /> 5 P il.5111 <br /> 5 - 13 114 . 7 y l X tyre s4 ;€k <br /> 5 P - 1 W 15).,Api W 1 ) 5"00 i I <br /> e+nquis e y ( ignalu(e) KOCCIVeG DYASignature) DatelTime <br /> 4w-�� T. A •T- r-;Y-4-1t`j 4AltAWI <br /> ti <br /> Rehnquish b! Y Signature) Received by (Signature) DatelTlme <br /> 11.25-6n A NO <br /> Re+nquished by (S+gnalur Re ved by Mobile Laboratory for held analysis (Signature) Date/Time <br /> Dispatched by (Signature) date/Titne Received for Laboratory by DatetTime <br /> Method of Shipment MDUA + Laboratory Name <br /> �Le. ?'( { L4 svi b-e <br /> Special Instructions VOA O&G METAL OTHEfIS I hereby <br /> autthhorr� �9e <br /> izethhee peerrfoorrmance of the above Indicated work <br /> GOOD COMATION APPROPRIATE �' <br />