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f Advanced CHAIN OF CUSTODOECORD <br /> ` Date agk/ Page _1—of <br /> -- GeoEnvironmentai, Inc. S26,� �,7 , l� <br /> 637 Shaw Road- Stockton,California-95215-(209)467-1006- Fax (209)467-1118 <br /> Client Protect Manager <br /> 4r—'A4? -A& -(.. -.Zj77-Z,-<- I <br /> Tests Required <br /> Phone Number <br /> Samplers (Signature) / Invoice <br /> Protect Name <br /> S75-cS_' <br /> Client <br /> FA <br /> Sample Location Sample type No of tl� <br /> Date TimeWater Solid , NotesN umber Description Air Conts �� r w ; �, 3 w ; <br /> Comp Grab r� r t J _ <br /> t <br /> ! KR <br /> rnW&/iOlt, IAAO" r <br /> f ' <br /> a <br /> e in s e y (Signature) I e y a Date me <br /> !7AW1 <br /> R uishe (Sig ure) R ived by (SI` al re / Da !Time <br /> Relinquished by (Ssgnature) Received by Mobile Laboratory for field analysis (Signature) ate/Time <br /> i <br /> Dispatched by (Signature) DalelTime Received for Laboratory by Date rime <br /> Method of Ship me z Laboratory Name <br /> Special Instructions ttrC I hereby authorize the performance of the above indicated work <br /> tt,C PRESERVATIONT�'jull)Wivul I AffhUfffilt CA"DU awV'11 Jca aj� 1 <br /> ,A <br />