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Advanced CHAIN OF CUSTODY RECORD ' <br /> GeoEnvironmental 111C. Date Page ---f of <br /> 111`071 Crdi/r)171i(l <br /> of Nrn <br /> AoI9 <br /> 1803 Wesl.March Lane, Suile A-Slocklon, California-95207-(209)956-0264 -Fax(209)956-0700 <br /> Client Project Manager <br /> I f Tests Required <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> Project Name A Y AGE 0 <br /> Zaww"� /,Jj& % / % Client ❑Fzr <br /> Sample Location Date Time Sample Type Solid No. of Notes <br /> Number Description Water <br /> Camp. Air Conts. <br /> 1z-5 VI/ ✓ 72134 <br /> I tp 72135 <br /> 17,-1 7213 ' <br /> 72137 <br /> 72138 <br /> 72139 <br /> e inqiished By: ( ignature) Iffeceived by:I(Si Date/Time <br /> 4 <br /> J <br /> 142--16 --9/6 Qmn 1--�d n : ( — <br /> Relinquished by: (Signatulej- NeceNed by: (.1ijnalure) I I Date/Time <br /> Relinquished by; (Signature) Received by Mobile Laboratory for field analyl ignri re) PRESMVATKTf&G 00 1 OTIR Date/Time <br /> Dispatched by; (Signature) Date/Time Receiv G;"QOQ�C�ON�D;Dlil ON rAPPRO AIATF oe Datellime <br /> I eMV-8PAMAnENT GONTAINW-�� <br /> Method of Sh'prn wo Ltp-5 FJ-C�,d 1 r] rj—Lf- Lahoratory Name <br /> 17 <br /> Special Instructions: <br /> re <br /> I hereby nuthorize the poirormance of the above Indicated work. <br /> 1 <br />