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i / ) CHAIN OF CUSTODY RECORE <br /> l Advanced <br /> . Date /2 I ?—57 Page ( of <br /> -- �' GeoEnvironmental, Inc. <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> Client + Project Manager Tests Required <br /> rC�(� <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> AGE <br /> Project Name /�� CI El <br /> Sample Type No.of <br /> Sample Location Date Time Water Solid Notes <br /> Number Description Comp. Grab. Air Conts. <br /> r <br /> L I rz-r i q50 006e2 <br /> r <br /> 00603 <br /> �3 15P <br /> t <br /> t 00604 <br /> rr <br /> ria f ; 00605 <br /> rr <br /> r 006 } <br /> ecetve y' rgnalure �;. <br /> ISM717'� <br /> DAe irr t715 c y: rgnayr ��r C <br /> p <br /> not edime h <br /> Relinquishe by-, r�gnatture) Received by: (Signature) WAS Q&G METAtS t1IHIn <br /> Received by Mobile Laboratory for field analysis: (Signature) `�' J PRFSFRVATIOIV Date imo <br /> Relinquished by: (Signature) C[ <br /> Dispatched by: (Signature) <br /> Date/Time Received for Laboratory b fAD SPACEABSLNT COidTxl�lEhS Date/Time <br /> Laboratory Name 67 <br /> 006 r <br /> Method of Shipment: <br /> ti%c I ._ <br /> I hereby authorize the performance of the t 00688 <br /> Special Instructions: <br />