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(� Advanced 1 C <br /> CHAIN OF CUSTODY RECORD <br /> -- .. GeoEnvironmental Inc. 222-9s <br /> - � Date � Page of <br /> of Northern California <br /> 1803 West March Lane, Suite A-Stockton, California-95207-(209)956.0264- Fax(209)956-0700 <br /> Client _ �LS- Project Manager <br /> 6 �9`I 1 /-� Tests Required <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> Project Name �L � AGE Ek' <br /> r Client ❑ <br /> Sample Location Sample Type No. of �a <br /> Number Description Date Time Water Solid Notes <br /> Comp. crab. Air Cants. <br /> MW I (Z ZZ 7'S 102 3v <br /> 1< _ 3 <br /> IS <br /> eceive y: (Signature) Date/Time <br /> ,1 <br /> etinquished by: (Sign ure) `'1 <br /> 2f3eceiv : (S nature +� D te/Timee/� g <br /> Relin wished b <br /> q y: (Signature) Received b obile L. <br /> atory for field analysis: (Signature) <br /> Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Date/Time <br /> Meth of Shipment: <br /> Laboratory Name <br /> Special instructions: <br /> -�� <br /> I hereby authorize the performance of the above indicated work. <br /> ;r ! J ! ! ! J ! ! J J J J J J J <br />