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-------- --------- -------- ...... <br /> Advanced y CHAIN OF CUSTODY ECORD <br /> GeoEnvironmental, Inc. Date-,L:3 12xt Page f Of <br /> ...... 4005 North Wilson Way-Stockton, California-95205-(209)467-1006-Fax(209)467-1118 1 <br /> Client Project Manager J <br /> Tests Required <br /> Phone Number <br /> to i�D 4!!: bp-&JE <br /> -� -V-X4-LP Samplers: (Signature) Invoice: <br /> Project Name < AGE ❑ <br /> )I� — J;v? atL Client* <br /> Sample Location Date Sample Type No. Of <br /> Ai 46L <br /> Number Description Time Water Solid Conts. Notes <br /> Comp. Grab. <br /> 284 -23 <br /> 28424 <br /> V1 <br /> rNTE <br /> rju T 1 01"N IMAI! <br /> Relirrqmnshed by: (S nature) Received by: ignatureDate/Time <br /> -Yer� 0" 1,41CD 0�"LV <br /> ure)gna <br /> y: (Sit <br /> Relinquished by: (Signature) Received bDaterTifne <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Datefflme <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Date/Time <br /> Method of Shipment: Laboratory N <br /> qC <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br /> -——-—---–--—--------------------------- -------------------------- <br />