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CHAIN OF CUSTODY RECORD <br /> ( Advanced w Date9d— Page of <br /> W GeoEnvironmental, Inc. <br /> 4005 North Wilson Way•Stockton,California•95205•(209)467-1006• Fex(209)487.1116 <br /> L <br /> Project manager Tests Required <br /> Client <br /> Phone Number <br /> piers: (Signature) Invoice: <br /> AGE <br /> Client ❑ <br /> )oject Name <br /> Sample Type S . <br /> w of <br /> Sample Location Date Time Water Air Solid Notes <br /> Z <br /> Number Description comp- Drab. <br /> o it, 99Ld <br /> fo; Ig C <br /> 2 3-2 3O 6llrt S �O',� <br /> L \ <br /> �J <br /> pt � Dot a <br /> eceive y: gnatuu - / 7 <br /> � <br /> U6 a ignaWte 4 6 <br /> D <br /> Date i e <br /> m <br /> N Felt quiehed by: ( gnawre) Received by: (Signature) <br /> Drde(rime Y <br /> Relinquished by: (Signature) Received by Mobile Laboratory Icr Held analyda:(Signature) <br /> 'i Dabornme <br /> m L <br /> Datel-rime curved for Laboratory by: <br /> N Dispatched by: (Signature) _ <br /> Laboratory Name <br /> m 1lethod of Shipment: <br /> - I hereby authorize the performance of the above Indicated vrork. <br /> n- Special Instruoricne: - - - <br /> m <br /> r— <br /> m <br />