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4 Advanced <br /> CHAIN OF CUSTODAECORD <br /> __- <br /> °�t <br /> GeoEnvironmental, Inc. =l�`�7-wags – — O <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> ClienPEOW Manager , <br /> Tests Required <br /> Phone NLknber <br /> �l <br /> Sampers: (Signature) Invoice; <br /> Project Name tvS )�� AGS <br /> �( � � � Client ❑ <br /> Sample Location Sample Type No. of <br /> Number Description Date Time Water Solid Notes <br /> p Comp_ Grab. Air Conts. t <br /> lam- nir� 1 r�, 4 70 34- <br /> e>< <br /> 4X �C 47035. <br /> .47036 <br /> 47037 ' <br /> X67 l aL4 47036 fl or <br /> s ra <br /> Received y: (SIg-n-a—tu—r-eF Date lTl re <br /> !.. <br /> Re' ss gnat. e) Repx y Tr u iER Date Ime <br /> oe <br /> r r , LQ �ILS <br /> Relinquished by: 11hocAtoty for field analysis: (Signature) Date/Time <br /> �1F`rli�)FFt,�l 4o; <br /> Dispatched by: wti DateTime R e€ d fo�Labaratory Dale/Time <br /> j w <br /> Melho��((of Shipment: , Lab r or Na e <br /> specfa�lnstructions: - f j I hereby authorize tht performance of the above Indicated work. <br />