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Advanced CHAIN OF4CUSTOD RECORD <br /> Dale �' { Page of"_ <br /> GeoEnviron mental, Inc <br /> 4005 North Wilson Way-Stockton,California 95205 (209)467 1006 Fax(209)467-1118 <br /> Client rl{a ,- / 1, Project Manager l� 1 I 1;1, <br /> I Tests Required <br /> Phone Number <br /> Samplers (Signature) <br /> \ } Invoice <br /> 1�l� 5 � Al ❑ <br /> _' <br /> ProjectName /a$T CtayPipp-p-rVj'� f Client <br /> Sam � <br /> Sample Location Date Time Water le TypWaterSolid No of ` Notes <br /> Number Description Comp crab Air Conts <br /> 94481 <br /> 94482 <br /> 944®3 <br /> �X >� �� -�� � <br /> ieLri. 594484 <br /> s4406 <br /> e y ( ign re} eceive y igrn re) cele!l Mme <br /> 4-I-4s C x`00 <br /> Relinquished by (Signature) Received by (Si nature) y �� Ret /Time <br /> r <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DstelTime <br /> Dispatched by (Signature) DatelTrme Received for Laboralory by Date(Time <br /> Method of Shipment Laboratory Name <br /> oU�r nrT i r/.tw <br /> ppb Lptr I hereby authorize the pert rmance of the above indicated work <br /> Special Instructions ( fRSEIl AMN C <br /> 60QQ CONDITION <br /> HEAD SPACE ABSENT CONTAEVMS <br /> r 1 , <br />