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i' <br /> _f) <br /> t R:. 1 2013 <br /> j Advanced CHAIN OF CUSTODY RECORD,; <br /> GeoEnvironmental, Inc. Date Page __ l of <br /> 837 Shaw Road- Stockton, California-95215 - (209)467-1006 - Fax(209)467-1118 <br /> Clientis +� ri rn+ Project Manager <br /> d }- items <br /> Tests Required <br /> -Phone Number <br /> Samplers: (Signature) Invoice: <br /> Project Name AGE <br /> G Lt c,r L►lu d r,�,! `j�� Client ❑ <br /> Sample Location Date Time Sample Type <br /> Number Description Water Air Solid C nts. J 01V Notes <br /> Comp. Grab. <br /> /355 <br /> {Zr3 3 ki"'d `4 i t 1335 f / <br /> �ZE3� r • 12-15 <br /> inquis a ignature} ecen+e y: (Signature) Date/Time <br /> .. L'ds c3 <br /> -Relinquished by: (Signature) Receivedby: (Signature) "'"" -' Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) Date/Time <br /> Dispatched by: (Signature) Dale/Time Received for Laboratory by: /JJ DatelTime <br /> ,g__Method of Shipment: _ " �:_. --�. �._,._ :.— __. Lab ory ame - _ ,_..�__ ..�._,__ �.. <br /> . = •` <br /> Special Instructions: �/ 1 hereb uthorize the performance of the above Indicated work. <br />