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• • i <br /> ( Advanced �7 � -� ,L z CHAIN OF CUSTODY RECORD <br /> GeoEnviron mental, Inc Date j "z 2� Page of <br /> 4005 North Wilson Way Stockton,California-95205 (209)467 1006-Fax(209)467 1118 <br /> Client �J Project Manager <br /> U J e c L vj t w �'�,, e TrTests Required <br /> Phone Number <br /> Samplers (Signature) L Invoice <br /> 1rV <br /> L� G � (L'� ° AGE 9 <br /> Project Name �I y` Client ❑ <br /> Sample Location Date Time Sample Type No of <br /> Number Description Water solid ti Notes <br /> p Comp Grab Air CUntS r <br /> M 2 <br /> qy 01 <br /> 6-2-Z -YY q; <br /> W- zDlid -2,Z - fy 3v 5 <br /> Pell uis 21bb (Sign lure) ecewe y ignai a Date/Time <br /> Relinquished by (St nature) Hocetved by (Signature) Datef ime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time the or Laboratory by Date/Time <br /> Method of Shipment 1 Laborat ry Name / ' <br /> Special tnstauc4ons I hereby authorize the performance of Ehe above indicated work <br /> �� (J <br /> t .� <br />