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Advanced C � _C` Z CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. °ace 21 I °5 Page _L of <br /> < � <br /> 837 Shaw road -Stockton,California-95215-(209)467-1006- Fax(209)467-1118 <br /> Client C'1AOA-u.> Project Manager <br /> De'vt V�L[VW 160'r.(t Tests Required <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> 4C <br /> Project Name ;,Gt r f�'S �' �i�� jp�to . l C AGE <br /> ClientClient�D <br /> El <br /> o. <br /> Sample Location Sampie Type Nof c3 <br /> Number Description Date Time Water Air Solid Corns Q� JG ��ti Notes <br /> Co.p. Grab. .ti <br /> C.f 7"1-- 0 C "Ti-el G, I D r Ol t3 5 <br /> CF-19- IN CXR `i � 1 �` �1 DH3 -05 4 X <br /> C,PT`i- l t"1 p T- L' i l'1 ' X X � X <br /> C Y-1-9- 15_r C.Q i-"1 r� 1,5-1 , <br /> WTq- 190 &-1`t Cf i oqL) L4 <br /> Relinquished y:( 19naturev <br /> ace e y:TV, ­atre <br /> on DaU/Ti e <br /> �_ t' di-f4' 05 Ih_w <br /> Heli fished by: (Signature) Received by: (Signature) Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) S -i q..T DateMme <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: `J. / DaterT me <br /> Method of Shipment: t labor ryNanIs <br /> Lra� ( Oce+ Ic;r� r Ca L T`I7c <br /> Special Instructions: I hereby authorize the performance of the above Indicated work. <br />