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j Advanced CHAIN OF CUSTODY RECORD <br /> - Date 2-Za-11 Page �a_ of <br /> Ge0EI1viron 1leIltal, II1C. <br /> ���•'•� 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> Client Project Managor- <br /> �(i / /0� Tests Required <br /> Phone <br /> Number <br /> A L'V� \ <br /> Samplers: (Signature) Invoice: <br /> [� <br /> Project Name - �r AGE Client ❑ <br /> Sample Type , <br /> Sample Location Date Time Water Solid No. of <br /> Comp. Grab, 442541 <br /> Number Description Air Conts. ` ''o. <br /> t <br /> S `` ✓ 40. 925�42, <br /> r <br /> No. 92543 <br /> Fie inquis y: (Signature) a ewe y: ignature 2 L Date/Time <br /> to <br /> � <br /> Relinquished by: (Signature) 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 Received for Laboratory by: Date/Time <br /> Method of Shipment Laboratory Name <br /> Special Instructions: UOAS ONMETALS OTHER.' I hereby authorize the performance of the above indicated work. <br /> 'CHS "RC-SER'JAT _ � I <br /> GOOD CONCITIOPJ �� APPROPR!AT E <br />