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Advanced 717CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date �� ~q { Page of� <br /> of Nonhern Ccthfonua <br /> 1803 West March Lane Suite A-Stockton, California-95207-(209)956-0264 Fax(209)956 0700 <br /> Client M 5 t"V PrZwkl <br /> ct Manager <br /> M r w i kk( t, Tests required <br /> P one Number <br /> Samplers (Signature) Invoice <br /> AG EK <br /> Project Name y��' r 51 !< <br /> 2 F,f�, . 4 �~I - Client ❑ <br /> Sample Location Sample Type No of <br /> Number Description Date Time Water Air <br /> Solid Conts Notes <br /> Comp Grab <br /> 3 7-71 y <br /> P 2.- <br /> 9 o <br /> Pz - 50 4 16 • �O I _ to <br /> P3- qo 011 l L4 <br /> P3 - 55` _ (3 <br /> e mquts e y (Signature) Receive y ignature <br /> y lD�ate/7ime <br /> 'Relinquished b (Signature) 4 ct A •7 ^L <br /> y ( 9 ) Received by (Signature) Date(Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatelTime <br /> Dispatched by (Signature) Date/Time Rec v or L boratory by D e[Time <br /> Method of Shipment Laboratory Name <br /> CA �7— <br /> Special Instructions 141 hereby authorize the performance of the above indicated work <br />