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� � I♦ I♦ � � � � � � � � � ii � � <br /> S Advanced CHAIN OF CUSTODY RECORD <br /> --_ GeoEnvironmetal, enc. Date I Page t of� <br /> 4005 North Wilson Way Stockton,California-95205-(209)467-1006 Fax(209)467-1118 ` <br /> Clienth v J �w�4 r Project Manager <br /> �` m C,,� 11 Q r Tests Required <br /> Phone Number <br /> aol 967 <br /> Samplers (Signature) q Invoice <br /> Project Name O�yW AGE <br /> i- of�� a raAa Client ❑ <br /> \ L <br /> Sample Location Sample pe No of � '� � o <br /> Number Description Date Time Camp Water <br /> Air Solid Conts �� r I Notes I <br /> _ 03 loot 1 j 3c) X y X <br /> 64483 <br /> r s 64484 <br /> wZ/oV3aa1 o33oof 17ZO <br /> �-'3 /o33oa i a3ooti 10 ►� X X ; 64405 i <br /> i <br /> 63)0'5 Ll 2-6 �C ?� 64486 <br /> wS�o336a <br /> 633oai `gC1.� i 64487 <br /> lae5 X 3 64488 <br /> V7 /033190 033v6i /K ` E� 64489 <br /> Bel s e y (Signature) eco ve y gna ure r <br /> ell u shed by (Signature) Received by (Signature) DatelTime <br /> Relinquished by--(Signature) Received by Mobile Laboratory for field analysis (Signature) Datetrime <br /> Dispatched by (Signature) Date/Time Received for s oratoryDate/Tirne <br /> Method of Shipment oratory Name <br /> 4'Ver 6 hfi _I f,LS OTHPR f�r! <br /> Special Instructions i I-- M �i' AU.- — I herebq authorize the performance of the above Indicated work <br /> GOOD CONIM1; 1 APPROPRIATE <br /> iLAD SPACL I CON jilt\-P,J ` <br /> 9orpivufl— d%f=:i�Ie&L 4 -.1 1a 'A. � .AAL %. ,,1_ A- <br />