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1♦ � � f♦ i♦ -:i� � .. .i♦ � mob <br /> IRTHT�%SVUG I.PEETALS 0TH_ <br /> l Advanced ���-�-=--� n,nr+n CHAIN OF CUSTODY RECORD <br /> ✓ i^,�'•r!�:trrrl��� .� � �3 �1� � <br /> Page <br /> --- GeoEnvironmental, Inc. �' ';5 �� 141416, Date of <br /> ' ' �h.t.i d:4�i k!(pi k.lY.�r <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006=`Fak,(Z09}4:67=1'i)f#..y'e ,:, <br /> Client Pro'ect Manage r <br /> i Tests Required <br /> Ph e� Nu,mber <br /> Samplers: (Signature) Invoice: <br /> Project Name AGE <br /> Client ❑ <br /> Sample Location Sample Type No of r ,� <br /> Number <br /> Description Date Time Water Solid V Notes <br /> p comp. crab. Air Conts. <br /> -- LID � � �l '� ✓ � � 50373 <br /> j1 5037$ <br /> 50375 <br /> 50375 <br /> 50377 <br /> 50370. <br /> 50379 <br /> a in s e y: (Signature) Received by; (Signature) <br /> elrnquished by: (Signa! e) Received by: (Signature) t ^ t DateJTime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Astax6e <br /> Dispatched by: (Signature) Date(Time Received for Laboratory by: Date/Time <br /> Method of Shipment: Labratory Ne <br /> , .,A. <br /> Special instructions: I hereby authorize The <br /> �efformance of the above indicated work. <br /> I <br />