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r r r r - r r r r r r r r r r r r r r r <br /> j Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date 5 i G ' Page of <br /> 4005 North Wilson Way-Stockton.California-95205-(209)467-1006-Fax(209)467-1118 <br /> Client Project Manager <br /> i r a <br /> TestsL Required <br /> v <br /> Phone Number <br /> t: <br /> Samplers: (Signature) Invoice: <br /> Project Name LClient <br /> i <br /> Sample Location Date Time Sample Type Solid No. of i� Notes <br /> Water <br /> Number Description Air Conts. <br /> Comp. Grab. <br /> Ipw)3t_ h,il,,�f{ `�� X /) viae <br /> ��r-1 C'ii IL Wr7WZ, <br /> QrW,W . -L G 't(:S pct <br /> C <br /> ngms a y' (Si n tura) eceive y: (Signature) Date/Time <br /> 7rae4n t5 t' <br /> elinquished by: (S nature) Received by: (Signature) Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) Dale/Time <br /> Dispatched by: (Signature) Date/Time caw dd for Labor I <br /> / or by: Date/Time <br /> Method of Shipment: ^ Lab ralory Name <br /> Special Instructions: I hereb authorize the performance of the above indicated work. <br /> I <br />