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CHAIN OF CUSTODY ECORD <br /> [ Advanced Date` page of <br /> GeoEnviron mental, Inc. <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467.1006-Fax(209)467-1118 <br /> Project Manager c, Tests Required <br /> Client � - ltil,�� tib/ <br /> Phone Number J 1 y <br /> Invoice: <br /> Samplers: (Signature) - 1 � <br /> AGE Z <br /> Cl ❑ <br /> Project Name y <br /> i <br /> Sample Type No. of <br /> Sample Location Solid <br /> . p Date Time Water Air Conts. .00706 <br /> Number Description Camp. Grab. <br /> 00707 <br /> 00708 <br /> 00709 <br /> 00710 <br /> TZ-1-7 41 <br /> 00711 <br /> -S <br /> 0n.712 <br /> Date[Ti <br /> 1nature ecerve y: ignalure { �, .� fit, /sem <br /> e IPqu1s a y: l i 9 yr l r J <br /> ater ime <br /> RA <br /> Relinquished by (Signature) Received by, (Signet ra) / �f h �l -r I!,,SCT„'1 Cf _uC ' <br /> } <br /> MCI J <br /> / j C _ ^r^-�,11�T rt..i Dato(rlme <br /> �' <br /> Relinqu�sh�d by: (Signature) <br /> Received by Mobile Laboratory for field analysis:(Signature) GOO r0 �l ITi��;,`— <br /> )V� 1 iil� r; <br /> Y F5 I' tAd%1)EIVT (� DalelTime <br /> DatelTima Received for Laborator b V r, t�G,`i lriiir.i5 <br /> Dispatched by: (Signature) <br /> Laboratory Name <br /> Method of Shipment: I"\ I hereby authorize the performance of the above indicated work. <br /> Special Instructions: <br /> . <br />