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( Advanced CHAIN qFCUSTODY RECORD <br /> GeoEnv ronmental, Inc. IDL _ � � Date Page -/— Of- <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467 1006-Fax(209)467-1118 <br /> Client <br /> 7� ~ Pro Manager <br /> Test Required <br /> P ne Number <br /> (7 <br /> s (Signature) Invoice <br /> Project Name �� �r ,� � AGE ,�� <br /> Client ❑ <br /> Sample location Sample Type No of � i 4 7 <br /> Number Description Date Time Water Air Solid Conts i <br /> Comp l3rab J-- ------ <br /> 4::�i"L— L W L <br /> 2- ---- --- --- <br /> ,� f 4 7 3 6 i <br /> k1l,)I Lei �C 473W*) - <br /> 1 <br /> IL <br /> 47364(13' <br /> 473s5 [fi� <br /> I <br /> Reflinqu7iod { tur Receivedy gnature <br /> Date/Time <br /> Rehnq fished by (Signature) Received by (Signature) Date/rime <br /> Relinquished by (Signature) Received by mobile Laboratory for field analysis (Signature) Date/Time <br /> 1 i <br /> Dispatched by (Signature) DatelTime c ved lar t aboraIbM <br /> Date/Time <br /> Method of Shipment } Laaratoly Na <br /> nle <br /> Specietlnalcuctions /� �; ;; �' Ir' J1 C I hereb orixe t <br /> C'FJCJ� P[BtJ2� / � y performance of the above indicated work <br /> t r�t1,ti II,P, <br /> t r , <br /> + LL- iL/l I 6 <br />