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f <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date 3-ZS �� Page of <br /> of Norihen► Califon►ia <br /> 1803 West March Lane,Suite A-Stockton, California-95207-(209)9560264-Fax(209)956-0700 g 3 38 L4 Q <br /> Client' Project Manager <br /> Tests Required <br /> Phone Number <br /> - <br /> f—; <br /> Samplers: (Signature) Invoice: <br /> Project Name ft /,'� , AGE <br /> LV Client ❑ <br /> .. Sample Type <br /> Sample Location Date TimeSolid No. of Notes <br /> Number Description Water <br /> Comp. Grab. /qtr ContS. t r <br /> ' 74775 <br /> a i <br /> 74776 <br /> L <br /> 74777 <br /> + <br /> � L <br /> er i e S nau Rec e i na <br /> - j�9 y� g _Y� (Sig F ,�� a4 � �7 �W wwVC �J IOC Dai 9 ime r-r�y, <br /> Jvl"/ /41: TSS 3 ! fj "'' <br /> Relinquished by: (Signa re) ived by: (Signa e) Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Dale/Time <br /> Method of Shipment: Laboratory <br /> Special Instructions: I herebyp author& a theperformance of the above indicated work. <br /> 00°�rj�f�:aS `:�i�l <br /> �.... <br /> , <br />