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e.s.w e� ttttttttwt� tttttttttt� ttttttttttt■ � � � �1 i• i• i♦ � � l• i♦ i• <br /> Advanced „ <br /> CHAIN OF CUSTODY RECORD <br /> ` d Date q-vs-o Pae <br /> ---- GeoEnvironmental Inc. of <br /> 837 Shaw Road -Stockton, California- 95215- (209)467-1006- Fax (209)457-1118 <br /> Client M Pro ect M na er <br /> �S Gc�iNI Tests Required <br /> �V' <br /> Phone Number <br /> Samplers (Signature) 0� Invoice, <br /> Project Name / a 17AGE�d ►��-- tt� 5te '� Client ❑ <br /> SamSample Typeple Location pate Ttrr�e No of <br /> Number Description Wa�01-b <br /> Air Solid Con0 Notes <br /> Comp <br /> ts <br /> v,3 rye/ <br /> 13 r� <br /> T-7 UZ 1- -7 � ! I <br /> e ' 'shed <br /> y ( rgnalureJ Flecerve y rgnelure Date/Time <br /> Relinquished try (Srgnatur f' r / Received by (Signnhue) Oalef ime <br /> HW S ACEONDITTt )N „L✓ MT" <br /> Retinquished by (Sig natur RmATRDb*jj IeLaboratory for field analysis (Signature) Aatefrime <br /> IN � <br /> �• <br /> t)rspatctred by (Signature) telTima Re aboraIt bye 0 /Time <br /> %;� - �U /i OGS <br /> Method of Shipment � Labor Na e 1 J <br /> G �G•G I/ <br /> Spacial Instructions I herab authorize a performance of the above Indicated work <br /> v.e <br /> � e�a/ <br /> INTACT VIA ro—/ <br />