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i i i i i i i i � i i i i i ■■� 4r titititt� <br /> CHAIN OF CUSTODY RECORD <br /> Advanced <br /> Date e0k-,-1{off Page —L_ of so- <br /> GeoEnvironmentai, Inc. <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467.1006-f (209)467 1118 <br /> Client - 3 � Project Manager Tests Required <br /> �n <br /> Phone Number <br /> ) L4 C�7- I da(0 <br /> S m ers ignature) Invoice <br /> t AGE <br /> Project Name S-Ili-ock:zko� 1�`0,.+1 'r) Client ❑ <br /> Sample Type No of <br /> Sample Location Date Time Water Solid Notes <br /> Number Description comp arab Air Conis <br /> tl ' I 4079 <br /> AV�- 1 4079i <br /> 40794 <br /> M } <br /> ''��'��� -►�0:7 " �' ? -c�-� 9'as x 3 40795 <br /> X ` <br /> 4079 <br /> 40797 4I� <br /> 11 lie l� � -OD 1�q0 40798 <br /> e q is a ( ignpturs <br /> Received y (Signature) ' <br /> ReMn N.(�9+�Laturey 1� IA(\S �/�j((� try (Signature) DatelTime <br /> ��t fYfiY LIV� ' M•���'f <br /> quished by (Sig 3�a r, + }, -� - Re+�eived by Mobile Laboratory for field analysis (Signature) Date/Time <br /> ��ispat�F)ed fr;(Srgnatur S Date/Time RpceJved for Laboratory by Date/Time <br /> + { Date <br /> 1 t rr �r�l i dill Y�3+�.�,,,,r, N q\ ✓ / j ry J/�' \ �J (S 1 l t '11, <br /> Method of Shipment 1 Laboratory Name 1 <br /> Special instructions 9 f hereby authorize Igo <br /> D.performance of the above indicated work <br />