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l• �: <br /> • • <br /> Advanced <br /> CHAIN OF CUSTODY RECORD <br /> - %' GeoEnvironmental, Inc. <br /> Date d Page —?-- of�_ <br /> 4005 North Wilson Way Stockton,California-95205-(209)467-1006-Fax(209)467-1118 1 O N `c <br /> Client Project Manager <br /> k�Ut_ 1 <br /> ty Tests Required <br /> 4 Q1 Phone Number <br /> qti <br /> 67`1dClC <br /> V <br /> Samplers (Signature) Invoice <br /> Project NameAGqp-,*A, <br /> �cr v v'y r f A0 D .� �C a Client ❑ <br /> Sample Location Sample Type No of <br /> Number Description Date Time CompVat(irrab Air Solid Conts '� y Notes <br /> Vw- y -30- f Y 2:150 X ,� <br /> e e Ra-ceived Dale/Time <br /> kt;t5-1at.�errj T•�r 2-q id <br /> Relinquished by (Segnalure) Recery d by (Signature) Date ime <br /> 7�t y ^��a <br /> Relinquished by (Signature) Re ed by MobilLaboratory for feed analysis (Segnalure) DalelTime <br /> Despatched by (Signature) DatelTeme Received for Laboratory by DatetTime <br /> Method of Shipment Laboratory Name <br /> C <br /> Special Instructions VOAS I O&G I METALS1 OTHER I hereby authorize the performan a of the above indicated work <br /> GOOD CONDITION._, APPROPRIATE <br /> HEAD SPACE ABSENT—IL CONTAINERS <br />