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j Advanced CHAIN OF CUSTODY RECORD <br /> _ Dr <br /> GeoEnyironmental, Inc. <br /> Date Page _� <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> 141-11q Za e <br /> Project Manage Tests Required <br /> Client LOc�I Aj� �f /ON / S/CpcGN <br /> Phone umber <br /> C <br /> f n Samplers: (Signature) �� Invoice:hu ) H112 T �YL ' '� AGE E <br /> project Name Client ❑ a <br /> Sample Typ No. of r <br /> Sample Location Date Time Water Solid Notes <br /> Number Description Comp. Grab. Alir Conts. 'l <br /> Chi <br /> r 91 z 3 X2 <br /> C. l <br /> WAS 0 G METALS 0 HER <br /> OOD CONDITION APPROPRI TE <br /> 1EAD SPACE ABSENT-2L CONTAINE S <br /> 9 <br /> ar s a i <br /> Dete/Time <br /> nature _ e y: rgneture 3�23�5r � <br /> yt/!/Ga" yy/IL S7� <br /> 5-011V0,4411.5 lf�T �S�}A � zz9Datt 3 :ooPs� <br /> Relinq hed by: (Signature) eived by: (Sig ature) e/Time <br /> ' <br /> Relinquished by: (Signature) Received by Mobile Laboratory(or lield analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) DateRime Received for Laboratory by: Date/Time <br /> Method of Shipment: Laboratory Name <br /> CAL o 111 4 G 1�Ff6(ee�.Jed �� � M c, Ch" be <br /> I hereby authorize the per(orman a of the above indicated work. <br /> Special Instructions: <br />