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Ar <br /> Advanced CHAIN OF CUSTODY RECORD <br /> - -- %' GeoEnvironmental, Inc 318 Date -r Page —L of <br /> 837 Shaw Road - Stockton, California- 95215 - (209)467 1006 Fax X209) 467-1118 <br /> Client F-QU Project ManagerAU r/ I <br /> Tests Required <br /> Phone Number <br /> c;zo 2) //(6,1 <br /> Samplers (Signature) f� Invoice <br /> /,� �\ AGE 4�--- <br /> Project NameC-TWA r J 7"L �� / <br /> �5 � �d d� k � � Client ❑ <br /> i <br /> Sample Location Sample Type No of !C V <br /> Date Time Water Solid Notes <br /> Number Description comp Grab Air Conts it <br /> �40 4314-01 13qk <br /> w aAl <br /> t1 2, oIzr'3 13a10 <br /> 4 w yd x,03 /K w 3 oy> -o /019 <br /> nay a31za � w1/ 1h 25 <br /> ok low0d.?1, Jh 3I Le l o <br /> L 40 ! W a31 L z3 169,11 <br /> M W ta5!L � W 7 631 Z d 3 j <br /> e+nquts y ignature} Received by gnature) DatelTime <br /> z o fG �S <br /> Relinquished by Signature) Received y el{Signature} ate[Time <br /> Relmqu+s atura) ATION d b Mobile aborator for field analysis (signature) batelTime <br /> GOOD C*NDIMNL�_ PROPRIATE <br /> a y <br /> Dispatch + jNj Qj DatelTime I Received t r Laboratory by atelTRme <br /> method of Shipment Laborato Name. ie—ll <br /> Spacial nStruGtlon i�� 1 hereby authorize the performance of the above indicated work { <br />