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i Advanced CHAIN OF CUSTODY RECORD <br /> v - Date 11-111-0+ Page � of <br /> GeoEnvironmental, Inc. <br /> u 837 Shaw Road - Stockton. California- 95215-(209)467-1006 -Fax(209)467-1118 <br /> Client 'wVCj-Q b �iQ0. .. Project Manager Tests Required <br /> ��,>., �Zal�b ac J1 <br /> Phone Number <br /> (--tvl) q-61-t \ <br /> Samplers: (Signature) �p� /' / l Invoice: <br /> Project Name �Ox 15 A" �� +4._�� r j /� , AGE El <br /> J / � / Client <br /> Sample Typei <br /> Sample Location Date Time Water Solid NO' °t //�/ (� q; / Notes <br /> Number Description Comp. Grab. Air Conte. ,'lam/' C��j sky <br /> c�Tb-�1 CPT_6 @ i,� ` 121f-off (3t5 x, — <br /> CS'Tb!- 11ee`t 11 (�C- I�111 13G10 X -- <br /> CT16'- ii'M If C 1'lt' 14`3` X, _ -- <br /> i <br /> eh�s-he y: ( ignaturs) aceive y: ignalure Date/Tim <br /> � <br /> her nq shed by. (Signature) Received by: (Signature) <br /> Relinquished by: IS ignaturel Received by Mobile Laboratory for field analysis:(Signature) �J f_�. Dab(Time <br /> Dispatched by: (Signature) Datef ime Received for Laboratory/ J �i _ Daternme <br /> ratory Name <br /> Method of Shipment. L o <br /> L. G\fc-'3'(A -T C4,_ <br /> Special Instructions: I hereby authorize the performance of the above Indicated work. T <br /> L.Q L' ��L <br />