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[ Advanced CHAIN OF CUSTODY RECORD <br /> y <br /> GeoEnviaronmental, Inc, �} ' t _ ' , f Date 3- 11-0 Page 1 of <br /> B37 Shaw Road - Stockton, California- 55215 (209)467-1006- Fax (208)467-1118 <br /> Client Van o Project Manager Tests Required <br /> To-1 Cje`k L�f <br /> Phone Number <br /> �Z 01-� LLL1u ` 1 Q0 <br /> Samplers (Signature) Invoice <br /> Project Nameii nn AGE <br /> v au F t C. +� S, 1 ��r r lU u cu Client ❑ <br /> , <br /> Sample Location Sama Type <br /> o of <br /> Number Description Date Time ' _ Water Air Solid Conts 'L� � Notes <br /> Comp Grab <br /> I AAZ <br /> AWS-k3 tcto.3 1445 <br /> r"t1�tr��a3 Liu 3 ZV, 7_/_ <br /> - <br /> r <br /> VV-7 /d rs2z <br /> 1 u!s a i ig nature ece Ve y Ig nature <br /> date ime <br /> y (S <br /> 3 x-63-117c7 <br /> efinqurshed bignature} Received by (Signature) Date/Time <br /> Refinqui b� ature) 1pRE8ERVATIlQN for field analysis (Signature) <br /> Date/Time <br /> U0 CCt Crl'S'0 I_ APPROPRIATE <br /> rn, rn <br /> Ulspatchgq(m�r,�Stttp�gj LAEL-pURV,DI Date/Time Received for Laboratory by <br /> Date/Time <br /> i <br /> Method of ShEpmant Laboratory Mame C <br /> Special instructions U I hereby authorize the performance of the above indicated work <br /> Litz <br /> R - r � <br />