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CHAIN OF CUSTODY RECORD <br /> j Advanced - <br /> Date ��_� "��� Page --a—of <br /> GeoEnvironmental, Inc. <br /> 837 Shaw Road-Stockton, California-95215-(209)467-1006-Fax(209)467-1118 <br /> client e +s�-W*L w. 4.- Project MaDna--gye�r l_ q Tests Regt*od <br /> T��i +- <br /> Phone Number <br /> Samplers: (signature) C I ' <br /> AGE <br /> Project Name ,i ``"` l` Cent O <br /> Sample Location Type Solid So NNe NCosem - Notes <br /> Number Descri ion Date Time Water Air n <br /> Comp. Grab. <br /> g--3 Wta4�4- 4'f;;; <br /> j-t-1- 15 <br /> if 2-0 <br /> G� c5j 1�22�• <br /> e+nqu+s s y: i9nature p eery nature l�f�'} <br /> _ DaulTime <br /> Rel1n ishe by: ( ignature) Received by:(Signature) _ <br /> Date/Time <br /> Relinquished by:( ignature) Received by Mobile Laboratory for field analysis:(Signabrn) <br /> D me w trrrW by: <br /> ate/1 ime <br /> Dispatched by:(Signature) tai l <br /> Laboratory Name - <br /> Method of Shipment: <br /> t -i- 1 hereby authorize the performance of the above Indicated work. <br /> Special Instructions: /\ ' +b i:lcokc lj :1 1f��> y) <br /> ' 2100 .. � <br /> ho�i t "Qr���l aG aLCk� )``lp�a�*1c �„ A�r+GB. uuc�5 1c Pe�tdu�S <br />