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Advanced CHAIN OF CUSTODY RECORD <br /> Date 1 00 Page of�- <br /> --- GeoEnvironmental, Inc. Qa ) <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> Client Project Ma ger <br /> Tests Required <br /> J . <br /> Pone umber <br /> '95 ' � h <br /> ers: (Signature) Invoice: <br /> Project Name ` AGE ❑ <br /> POL S i Client ❑ <br /> Sample LocationDateTime Water Sample Type Solid No. °f Notes <br /> Number Description: Air Conts. <br /> Comp. Orals. ' <br /> AI <br /> X r <br /> 48682 �' <br /> #M.&r k I a * Iff <br /> It c? 48683 <br /> A3 48684 ; <br /> 48685 0�r <br /> ( �f ISG rr,4lti;nftli'MIRL, UM <br /> y: g tl..• t'i::i i I..i1 s: n i»:.:... i <br /> e nq a y: ( ig ature eceive (Sign o =�� r1• iyt:��l-•�i�it � DatelTime <br /> ' r^�,r �.�;,fYt -tlr''f'p:i <br /> 1 iEA0 ;fi�j ,1'9PuE a I <br /> Renqutshed by: Signature) Received by: (Signature) Date/Time <br /> i <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) Date(Time <br /> Dispatched by: (Signature) Date[Time Modlo,L b story by: Date/Time <br /> 12k <br /> Method of Shi t: Laborat am <br /> Special Instructions: �J f I hereby a o e the a ormance of the above indicated work. <br /> is 1Q C3t t(t r �t'd� d ► c> - ,fit n G iD <br />