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I I I I ! I 1 ! I I I I ! I I 1 I I ! <br /> Advanced <br /> CHAIN OF CUSTODY, RECORD <br /> ? <br /> Date c.t Pae L� 5 <br /> GeoEnvironmental Inc. ) -` or <br /> 837 Shaw Road - Stockton, California - 95215 - (209) 467-1006 - Fax (209) 467-1118 <br /> Prfl ect Manager <br /> Client L Tests Required <br /> Phone Number RC1 <br /> Samplers. (Signature) ti Irnroice: <br /> AGE <br /> Project Name ��r= = CL ;` �_ .� / Client ❑ <br /> Sample Location Sampl Pe Solid No. of �` �� Notes <br /> Number Description Date Time Water comp. Grab. Air Coats, <br /> wwDSzl-cit <br /> wJ L1 N`ti�Z L'tw �' r — <br /> wu 01 <br /> I V W, -( <br /> Relingws a gnature ecetve y' rgnature rlala/Time <br /> Re uished by: (Signature) Received by: (Signature) Date/Time <br /> RelinquiIt ATS eceived by Moblle Laboratory for field analysis: (Signature) pate/T-ime <br /> III PAC ABSENT_ 6CONTAINERS—____ <br /> DECHLORINATED IN LAB PRESERVED IN LAB <br /> Dispatched b ' (Si nature�OAS Oa[i METALS OTHM Date(Time Rec a aboratory by:���,� Dat Time <br /> PRESYERVi�TIdN <br /> Laboratory Name <br /> Method of Shipment: et <br /> M <br /> Special Instructions: C- • t I her hy'a thorize the performance of the above i icated work. <br /> RECD SEALED &INTACT VIA <br />