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it»»»»»» �f� � t>711111111� � iitttittttl� IF 7ilir � i <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date 6-2-9 —V Page z- of a2— <br /> of Not7hr i Cohfomw <br /> 1803 West March Lane Surte A Stockton Cafilornra 95207 (209)956-0264 Fax(209)95&0700 ��(�� A (/ <br /> CllentProject Manager <br /> P35 CO R S�►" dll�e t IM M � Tests Required <br /> 1b t <br /> Phone Number / <br /> (meq) q 5'G -03o -) /� <br /> Samplers (Signature) / Invoice <br /> Project Name D S5 Coi457rgcTI otl `N/XX / AGE CK <br /> 6�, Client ❑ <br /> Sample Location Date No of <br /> Sample Type <br /> Number Description Time Water Solid �Z` Notes <br /> p comp I Grab Air Conts <br /> X Coy, C)0-1 y = L <br /> ss - q X 1 <br /> S5- ID <br /> X AI <br /> L I I I 1 1 1 1 1 1 1 1 <br /> 55 � ! lo`-off X E <br /> I <br /> Relinquished y ( ,gnature) a by ignat r a , aG _ DatPITe <br /> i <br /> /6 140 <br /> Relinquished by ( ,gnature) eived by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Date/Time <br /> ethod of Shipment}} I C 1 Laboratory Name <br /> rt` �Je�cc( 9-4K&C� M t Lai ked <br /> Special Insttuctl6ris. I hereby authorize the performance of the above indicated work <br /> MS nxi KRtV "ILEI I v� , � <br /> ��,t, <br /> 1 _" Ulf <br /> °.I,;PACE ABSENT-3L COMIN n <br />