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i • i <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvlronmental, Inc. Date o Page —L— of <br /> - . 2�Sffp�GOre�l <br /> 4405 North Wilson Way-Stockton,Caldomia-95205-(209)467-1006-Fax(209)467-1118 <br /> ChantProject Manager� IAF ���" LLL LTests Required <br /> Phone Number <br /> 2bT �9 —/,006 <br /> Samplers (St nature) Invoice <br /> Protect Name AGE M lyllQlt� Client ❑ <br /> V _ <br /> Sample location Sample Type No of �}�' _ i <br /> Number Description Date Time Water Air Solid Conts t 66117 <br /> COMP7 Grab <br /> Ile J( x 1 66116 <br /> v6u o f iy�o J( ,x -xI Al66119 <br /> °/ZV.O/ <br /> 66120 <br /> k i <br /> 1 <br /> rWzVa1 66121 <br /> �lZ/O �C t 661�2 <br /> 66123 <br /> aye 1 <br /> 11330 f <br /> Relinquis y + ature) ecerve y (Signature) Da (rime `' <br /> J1 A tJ <br /> Relin4weifWd by Signat ) Received by (Signature) VaterTime <br /> Relinquished b (Signature) I <br /> q Y ( 9 ) Received by Moble Laboratory for Haid analysis (Signature) DatelTime <br /> Dispatched by (Signature) Dale/Time Received for Laboratory by Datefrime <br /> Y40 Ceza, (r AIAr alzS lob i�3UU n <br /> Method of Ship t a VOAS FSG hr�cTALS OTHER Laboratorye. <br /> �'Nama d <br /> i <br /> Special lnstruc,ons + t hereby onxa the parlor ance of the above indicated work <br /> GOOD CONDITION � APPROPRIATE r��oiur rt Iccl' 'c � <br /> HIw4DSPACE Ard'SENT CONTAINERS <br />