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t Advanced CHAIN OF CUSTODY RECORD <br /> GeoEftvironmentai Inc �5 Date �� Page _IL of f <br /> B37 Shaw Road - Stockton California Q6215 (209) 487 f o06- Fax(200)467-1118 0 <br /> a� <br /> ClientProject Manager r a <br /> _-- -- C Tests Required Y <br /> r Phone Number 3 <br /> i< <br /> C <br /> Samplers (Signature) Invoice n <br /> Project Name / r AGE Y <br /> Client ❑ <br /> / <br /> Sample Location Date Time Sample Type Solid Na of 16 <br /> �C <br /> Nutnber Description Water Air Cants Notes <br /> comp Grab <br /> H-7 d �f l 0�l J� ` K ,C 82011 <br /> Ea $ r - 82012 CA <br /> azo `o <br /> 10� (S� 0q� <br /> ---62014 <br /> 1L -1 to 1 .35 82015 <br /> 0 <br /> qua <br /> ed ky gna r ace ve y gnature <br /> R@104ulshed b ( r nature 1� r ! r <br /> Y 9 Received by {S14nwture)W L ❑ste(T4me � <br /> a <br /> Aelinquishad by (Signature) f{scerved by Mobile Labaretory(or field analysis (Signature) Date/7rmo <br /> 0iapatchatl by (Signature) Uat.M.. Reserve or aboratory b t3 ts/7ime <br /> G� n <br /> Method of Shipment <br /> r Lobar 1 ry Neme <br /> t m <br /> Cl ?� PflE5� Vl���a � <br /> Special Instruelions G thereby authorize the arinrmance o[ the aLovs indicated work <br /> f lEAO SPACE ABSENT,, LL CONTAII'ERS,.,E 10&t <br />