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-- - -- -- - - -- - — -- - - <br /> ( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Datez/ Page �_ of <br /> 837 Shaw Road-Stockton, California-95215- (209)467-1006 - Fax (209)467-1118 (0 Z fr <br /> Client / r Project Manager J 7 <br /> �� YQ �LGx Tests Required <br /> Phone Number /� <br /> Samp ers: (Signature) Invoice: <br /> Project Name., 1 q 9 AGE <br /> �.! <br /> AlG T /� el//,��''r�+ IRA 2—" x Client ❑ <br /> Sample Location Sampie Type <br /> Number Description Date Time Water Solid NO ° Q� Notes <br /> p Comp. Grab. Air ContS.:4:1 <br /> PAP63 A. 3 I <br /> C-32ica 166e. <br /> hawZ o A663 a 3 /5 3y n <br /> -X I <br /> d 3 ;L1 03 X.; .2-140 31 Gla <br /> '--w 0 3 d" Q 3 !'t 1.r5 6,3 xr o i 3 1( <br /> quis a y: atu e Weceived by:Tglgna;-reF'Rgte/Ti e <br /> inquished by: (Signature) Received by: (Signature) Date ime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory Datelrime <br /> �� ,,-4, <br /> Method of Shipment: L oratory Name <br /> C-�iL J-t'/1,Lf r �'C <br /> Special Instructions: I hereby authorize the performance of the above Indicated work. <br />