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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date IX-N -04 Page I oto <br /> T3 837 Shaw Road-Stockton, California-95215-(209)467-1006-Fax(209)467-1118 <br /> Client Ck"-5 ` ";It"A Pro'ea Mana <br /> Tests Required <br /> Phone Number <br /> W-7 <br /> Samplers: (Signature) � L j ',j Invoice: <br /> Project Name L'S flu � i AGE � <br /> rly ' i j/ CIIeM ❑ <br /> Sample Location I Date I Time Water Type Solid No. of /'�`� i / ;/ / Notes <br /> Number Description camp crag Air Conts. "),q/v4 <br /> `/ j <br /> C10--s -V8cPT 3 tI 18Z' iz-l4 q 32 <br /> CeTt� —ui e,4 rs l` rz-fes I5bi4 <br /> C-PTS .4 )C. s' a-1(' )sa 1 <br /> CPi -t5S ;CPT- iS ' iZ-1�> civ.,;, <br /> Felin a by: ( 'gnat ) ecmve y: rgnature Date/Ti1 <br /> 17 12-I6 714me ncx> <br /> RtIlinquished by: (Signa ) Received by: (Signature) ICA.� Dale{Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) Dete/Time <br /> Dispatched by: (Signature) DateRime Received for Laboratory by: DateRime <br /> J <br /> Method of Shipment: Laborato eme <br /> G� G�f I GJ r"A <br /> Special InslructionsI hereby authorize the <br /> perlormance of the above Indicated work. <br />