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CHAIN OF CUSTODY RECORD <br /> Advanced Date ao 77 Paged of-,3— <br /> GeoEnvironmental, Inc. <br /> 4005 North Wilson Way Stockton,California 95205-(209)467-1006 Fax(209)467 41118 <br /> Pro' ct Manager Tests Required <br /> Client ` <br /> Phone Number <br /> Samplers: (Signature) y, Invoice: <br /> Q AGE <br /> Project Name Cafe <br /> Sample Type No. of A <br /> Sample Location Date Time Water Solid / ' Notes <br /> Number DescriptionAir Conts. , <br /> Comp. Grab. 00689 <br /> t2-0 1 <br /> r ' 00690 <br /> r ' <br /> 1 00691 <br /> Rl�b r. <br /> I 00697 <br /> �C 0 -� t 00693 <br /> 00694 <br /> �3 006( <br /> 0 uar r t 1110 <br /> Tnatu ecervep y: igna11ture O, <br /> arnqurs e i g r-LVIC-4, p._'•-•'. y <br /> ReTli�nquished; y: SignaWre) Received by: (Signature) er1 OA! � `7 I J "ICR <br /> -DAI t0 MOft ' ICS 1/� 1�11faf.fllft111�J1'1 a me--- <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysIs:(Signature) GOOD COPlG1T � <br /> i4N <br /> Dale/Time Received for Laboratory by frill 11I ljI �� I r)ik�i 11 Dale/Time <br /> Dispatched by: (Signature) l <br /> Lebora ry Na a <br /> Method of Shipment: 1 <br /> I hereby sulhorize the performance el the above Indicated work. <br /> Special lnstruclions: <br /> U�� <br />