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a <br /> ( Advanced CHAIN OF CUSTODY RECORD <br /> � <br /> GeoEnvitonmental, Inc DateD;A%01 _ Page of-3 <br /> 4005Borth Wilson Way Stockton Ca[ifornla-95205-(209)4671006-Fax(209)467 t 118 <br /> ClientT Project Manager <br /> flau w r T% (,.,\ [�.}C I c� Tests Required <br /> Phone Number <br /> �J <br /> U,UC 90 <br /> Samplers (Signature) c� Invoice <br /> Project Name AGE <br /> b� \ Client ❑ <br /> Sample Location Sample ype No of ,�`� � <br /> Number Description Date Time Water Air Solid Conts ,3578 <br /> Comp Grab t <br /> i <br /> 53579 t <br /> � z o 013Mot 1�t� 1 <br /> 3 63588 <br /> two <br /> /0 3�tlia3�► � 1�1 u K j <br /> /u3�t�o, 6ISM01 Ills() -3X x 63581 <br /> IZLIU X 63582 ; <br /> II)LZ 03'��a <br /> d3�►tuj ��.z�.� x f 63583 <br /> 1 <br /> 101 '63584 v3�tvi Itis >C `63584 <br /> � +oq. � 03zt n i is l.S <br /> Rol—i quis e y (Signature) Receivedy (Signature) Data/Time <br /> al quished by (Signallire) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatelTime <br /> Dispatched by (Signature) Date/Time Received,fot Laboratory by Date/Time <br /> Method of Shipment Labofgtory Name ' }_ <br /> 90 <br /> C MC <br /> Special instructions V0ASJ O&G METALS OTHER 1 hereby authorize the performance of the above iiidieated wotk <br /> r <br /> GOOD CONDITION ''� APPROPRIATE <br /> HEAD SPACE ABSENT_._. CON MM-U) _�___ <br />