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r— r r r r-- r r r r-- r r r r r-- r-- <br /> Advanced CHAIN OF CUSTODY RECORD <br /> _ GeoEnvirorunental, Inc. Date 12 Page of <br /> of Norrhem CaMfornia <br /> 1803 Word March Lane,Suite A-Stockton,California-85207-(2D8)W6-0264-Fax(209)OM0700 <br /> Client Project Manager <br /> Tests Required <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> " r AGE Q <br /> Project Name (� <br /> — - �-}' y - O)-4( _ (._____ • Client p <br /> Sample Location Sample Type No.of ��� <br /> Number Description Date Time yyater Air Solid Corns �^ Notes <br /> Comp. Grab. <br /> Z S r Z S dSAMpI i X 1 d > <br /> PA R . 110 <br /> 7 � <br /> e mgws s n re scene y: (Signature) Dateriime <br /> =PA crp,9 <br /> elinquished by:(Signature) Received by: (Signature) Dat*Mme <br /> nqu shedy:( gnature) Received by Mobile Laboratory for field analysis:(Signature) DataMme <br /> Dispatched by:(Signature) Date/Time Becelved for Laboratory by: DetUT inn, <br /> Method of Shipment: Laboratory Nam <br /> C P, ---PTTIE <br /> Special Instructions: I hereby authorize the performance of the above Indicated work. <br />