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-- -- <br /> 4 <br /> ( Advanced r CHAIN OF CUSTODY RECORD <br /> Date Y r "o Page Of <br /> GeoEnvlronmental, Inc. —��q �c& <br /> ,.- l GG�4�A��� <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> Client ��� clu� Project Manager - <br /> 9?141, 1-Z.f Tests Required <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> Project Name ~` AGE [3 <br /> Client <br /> Sample Type <br /> Sample Location Date TimeNo• of <br /> Water Solid Notes <br /> Number Description Camp, Grab. Air Gonts. � <br /> CA23�-dv 6 f <br /> 36318 <br /> T)bn— 44 c <br /> ,36319 <br /> , <br /> ^ mxG t;CjA CI T rn <br /> HEAD SPhC AnE;dT — CON <br /> I"VU U04 %V. LfrL- UL2rMrr <br /> e inquis a y: (Signa Received by: (Sig-n-a-k-u-r-eF Date/Time <br /> Yen .Cam 41-2s7w 0- , r7 <br /> e inquis ed by: (Signature Received by: (Signature) Date/Time <br /> Relinquished ay: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Dale/Time <br /> Method of Shipment: Laboratory Nam J <br /> Special Instructions: I hereby authorize the performance of the above indloated work. <br />