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Advanced CHAIN c CUSTODY RECORD <br /> _-- GeoEnvironmental Inc. Date 1 Page —L— o(� <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> Client ProjectManage <br /> Tests Required <br /> Ph ne NLgnber <br /> Samplers: ure) '� Invoice: <br /> Project Name � [�Vr7�12� S + / AGE , <br /> Client p <br /> Sample Type <br /> Sample Location No. of <br /> Number Description Date Time Water Air Solid ContsNotes <br /> . <br /> Comp. Grab. 16682 <br /> w 11s� q "X <br /> 16683 <br /> It 5 16684 <br /> V VY 16685 <br /> lot( <br /> t asses <br /> r <br /> selin y: S g tur scows y; (Signature) q rA I te/Tlme <br /> Reli quis ed by: (Signature) Received by: (Signature) DatelTime <br /> Relinquished by: (Signature) Received by Mobile Laboratory lot field analysis: (Signature) DatelTime <br /> Dispatched by; (Signature) Date/Time Received lot Laboratory by: Dale rime <br /> ICE" P V &1 IFAI$ OI boral Cm <br /> Method Shi men • (G({• <br /> I�t <br /> Special Inslructians: RI APPROPRIATE ereby authorize e p rm ce of the above indicated work. <br /> CL/Y ' <br /> CONTAINERS, �.—.. r <br />