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�. �. ,,- ttttttttttw ; tiftft� �� I• M <br /> Advanced CHAIN OF CUSTODY RECORD <br /> _ GeoEnviron nenW, Inc. Date ?-/Z r°� 7 <br /> nage of <br /> =" of Northern Calrforrua r <br /> 1803 West March Lane,Suite A-Stockton California-95207-(209)956-0264-Fax(209)9560700 <br /> Client Project Manager <br /> !C �� Tests Required <br /> Phone Number <br /> Samplers (Signature) rl Invoice <br /> Project Name / - �, AGE vd <br /> Client <br /> Sample Location Sample Type <br /> Number Description Water Time Water Air Solid No of <br /> Notes <br /> Comp Gra <br /> 1 <br /> 1 rim <br /> e!'nqu h d by (Signature) Received y ignature Date(Time <br /> , "�2� A"J�Reiin unshed b (Signature) IV�V "-�' ` Z- <br /> q y ( 9 ) Recer a by (�Srgnature) Pale/Time <br /> j L// 4—( L 5/667 <br /> Relinquished by (Signature) Received by Mobild Laboratory for field analysis (Signature) DatelTime <br /> T– <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Date/Time <br /> s � <br /> t Method of Shipment Laboratory Name <br /> Cie LL lr' o3 e l <br /> Special instructions �,� I hereby autlVorize the performance M.We above Indicated work <br /> 1 ~ <br />