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� � � � i� i• � I• � � i• i• � � � � � i• i� <br /> { Advanced CHAIN OF CUSTODY RECORD <br /> tam <br /> --- GeoEnvironmental, Inc. C1 <br /> Date Page �— of_�^_ <br /> -F- <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> Client MZ P Project Manager Tests Required <br /> Phone Number <br /> 9Cf L 1 as <br /> Samplers: (Signature) Invoice: <br /> Project Name Lod } AGE <br /> Client ❑ <br /> Sample Location Sample Type s <br /> Date Time Water Solid No. of Nates <br /> Number Description Air Conts. <br /> Comp, Gtab. <br /> 50100 <br /> Y Eom- Del ,. j. f )r 50101 <br /> 50102 <br /> t, - <br /> k4r-z-b50103 <br /> a x <br /> Ir „ ., .� 1 Ll �, 50104 0104 <br /> lv �or� well 13�� <br /> 1f 50105 <br /> e+n uis y: ature) ace va y: gnature <br /> Date(Time <br /> Re inqu sh by: (Signature) Received by: (Signature) DatelTime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) <br /> Date/Time <br /> �. <br /> Dispatched by: (Signature) Date/Time Received for Lab a ry by: terTime <br /> l� <br /> 4 <br /> I Mhod of Shipme�nt:`,,�� � Laborata�ryM1 Name � <br /> Special Instructions- l hereby authori the oerformance of the above indicated work. <br /> I <br />