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[ AdvancedCHAIN OF CUSTOD �ECORD <br /> Date L0 <br /> Ge0EnvnonnienLal I11c Page 5 of <br /> - <br /> 4005 North Wilson Way Stockton California 95205 (209)467 1006 Fax(209)467 1118 <br /> F <br /> Client Protect Manager ; <br /> l <br /> l�r✓► f{� �� Tests Required <br /> 4 11 <br /> Phone Number <br /> 1-167 6 <br /> Samplers (Signature) Invoice <br /> h p / v�1 , AGE ; <br /> Protect Name C [� f•p ruc[ s]Io Client <br /> Type Typ <br /> = Sample Location SampleNo of <br /> Number Description Date Time Water Air Solid Conts w _R Nntpq i <br /> Comp Grab j, <br /> oq; q5 X 1 o <br /> Y' it t <br /> 217, <br /> lw� 5 3 _ aTM <br /> -1320 8 <br /> g 1 - 10 15 ! 00 <br /> -32_0_. <br /> i <br /> 6 1-1 -30 6-10-5 q l <br /> 5 <br /> 1 , '1 3211 <br /> p 1 <br /> ` r t , <br /> el' quis ed y {Si atu } y ( ignat ./ 1]ale! ime <br /> - 4 �� A <br /> D5� _ 6�14•47 13z36 <br /> Relinquished by (Signature) Rec ed by (Si nature) i 7r fry)»�r�. f� ` - <br /> { A7�nf1VOAS &G <br /> ff�, <br /> Relinquished by (Signature) Received by Mobile Laboratory for held analysis (Signature) II�Ut PREJER1f.-I-1 <br /> GOOD CONDITION APPROPRIATE <br /> Dispatched by (Signature) Date/Time Received for Laboratory MW SPACE AKEN I Date[Ttme <br /> Method of Shipment Laboratory Name <br /> t f} f?v'Itf L11 t4T M `L.awto, ( I - <br /> Special Instructions I hereby authorize the performance of the above indicated work <br />