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rr r� �r rr r r r r r r rr rr rr rr rr rr rr ■r ■� � <br /> Advanced <br /> CHAIN OF CUSTOD%ECORD <br /> ,r <br /> GeoEnviron mental, Inc Date -�`�-v� Page - of <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467 1006-Fax(209)467-1118 <br /> Client Project Manager <br /> L Tests Required <br /> Phone Number <br /> Samplers (Signature) L Invoice <br /> Protect Name AGE <br /> 0�� <br /> \ Client ❑ <br /> Sample Location Sample TypeNoof <br /> Date Time Number Description Water Air Solid Cortes �Q� Notes — <br /> Comp Grab 35118 <br /> +13 Ob <br /> to 16 r5 , - - 35119 <br /> 35120 <br /> __ 35121 <br /> )< ,---35122----- <br /> l�l,� 35123 i— <br /> r �7 35124 �` <br /> I l� 1 2- t7J r <br /> f r <br /> e irn is e �( n <br /> ) ec—et ve y ignature Date/I ime <br /> t n s� <br /> Rehnquishe ) _ Recer ` lure t Date/Time <br /> C i t 2,1 -- ---L _.--'-- <br /> Relinquished by (SI1 E�y�e) ' _ Air rved by!! ile Laboratory tot field analysis (Signature) Date/Time <br /> i�C torr SSi.^i t 4I Ir <br /> 1 s� l liJ <br /> Dispatched by (Sig , 1 iv t;. �' --� Date/Time Ra of ed f r Laboratory by Date/Time <br /> 1EAD SPADE 3S�ts� u <br /> Method of Shipment Laboratory Name <br /> 1111rAi 'q <br /> Special Instructions — 4 r i hereby authorize the performance of the above indicated work <br /> C o C u LJ1 YJ C;k- <br />