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( Advanced CHAIN OF CUSTODY RECORD <br /> GeoE%lvi%o&1ri1Dntal, II1C. �j/-7 .y 7'�', Date �' Page -� of <br /> 4005 North Wilson Way-Stockton,California 95205-(209)467-1006-Fax(209)467-1118 <br /> Project Manager <br /> Client {fida��q � ;�, t Few �,��� ; , '�t, . � .. Tests Required <br /> Phone Number ; <br /> Samplers (Signature) i Invoice <br /> Project Dame V—Le- ,tt AGE [[ <br /> Client ❑ <br /> Sample Type <br /> Sample Location Date Time 1Nater Solid No of Notes <br /> Number Description �r Coltts <br /> Comp Grab <br /> V 54757 <br /> 54768 <br /> Nu3y- i�' Its 1� 54769 <br /> 54770 <br /> 591771 <br /> 54777 <br /> ,,�Fialinquj.shedy Signature) "ereivea By lgnature 64773 <br /> Relinquished by igna ure) Received by (Signature) f t� � �"4r ,��, { '��f Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) f Date/TEme <br /> Dispatched by (Signature) Date/Time RecePve I for Laboratory by% Date/Time <br /> Method of Shipment Laboratory Nam T� <br /> Special t"SltuCtiona ra I 1 _ it .. ! ( 1 hereby authorize th& performance of the above Indicated work <br /> h" <br /> a, <br />