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I• tl• I� � � � � � t� t� t• � � � i• � l•� f• <br /> • s <br /> ( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc :� O-I V' z 111 Q, do c_, Date t Paye of <br /> 837 Shaw Road - Stockton California-95215 (209) 467-1006 Fax (209) 467-1116 <br /> ClientProject Manager <br /> ` Cv t � Tests Required <br /> Phone Number <br /> QQ - '-1G7- I 0410 <br /> Samplers (Signature) •� Invoice <br /> Project Name �r R ' '�� �r �7� Y <br /> Client ❑ <br /> Samplb Location o <br /> Sample Type Nof ti ' <br /> Rate Time Water Solid �'� � � 84745 � <br /> Number Description camp Drab Air Conts - <br /> 84746 r <br /> 0k7-%Z0)/, tt- o , Q950 -_84747 - -- <br /> go.14 It�o01 It-3u-1 101 / r` X <br /> ---84748 _-- <br /> f4t�ta ►���t t�-�� t��,c� � X � X � ti <br /> '7t Its i l Icy <br /> �� X X v <br /> �_54749 <br /> (99 ro rl3cw 1i- , I A�z y X X X __ 84750 - - <br /> rll1i-tl�j 3wIt 3a v1 �s®� 84751 <br /> ReILVD1.116hed by ignature -Received by (Signature) <br /> r n VOAS X17 hF1L4lS 01', , Ov <br /> of uis a y (Signature)by (Signature) Received b S3 I�L� PRE'RIVAT10N <br /> 44 LL / DateJTlme <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis ( s Ani ISI Date/Time <br /> � i� E nt�L) /�NTV LIaS <br /> Dispatched by (Signature) DatatTtme R I d fo.l Laboratory by Date[Time <br /> Method of Shipment Laboratory Name/�ff <br /> C& <br /> I { C <br /> Vitt.al lnsttucttons j I hereby authorize the performance of the above indicated work <br />