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I Advanced CHAIN OF CUSTODY RECORD <br /> Date ?-Cq-05 Page of _ <br /> GeoEnvironmental, Inc 1 <br /> 837 Shaw Road - Stockton, California-95215 - (209)467-1006 Fax (209)467-1118 <br /> Client .� Project Manager <br /> W, #iotit.. g C-4¢f/L- Tests Required <br /> Phone Number <br /> y(7-1 ao� <br /> Samplers (Signature) Invoice <br /> Pro)et:t Name LU �/ ea.f`>•'"C6AGE .® <br /> -e�6� pl�� Client ❑ <br /> Sample Location Sample Type <br /> Date Time Water Solid No of �` Notes <br /> Number Description Air Conts <br /> Comp arab <br /> p8a h'`w Z <br /> Ntf,1 y aif•JS 3 Li W ' f /t 2-:5 f <br /> --kW oiieo3 w�w 5 l` l l a5 l <br /> t►kwl $"03 y--,W <br /> w U Q o VA t�f $ <br /> is e y ignature ace ve y rgnature Dale/Time <br /> d7 /40,3 <br /> Relinquished by (Slgnatur ) Received by (Signature) Datel7ime <br /> ICPlt' <br /> fieiinqu�shed by ( gr r� ABSENT. d by Mobile Laboratory for field analysis (Signature) Date(Time <br /> DECHLVrJ2UU&U LN ER D IN I,AA)3,,,,,.,.,,,_ � *' <br /> Dispatched by (Si XAvAnDate/Time Received for Laboratory byG,, -% Da e/Time <br /> - G <br /> Method of Shipment ore o acne <br /> G <br /> 5pema))wTuollonS I hereby authorize the per rmanca of the above indicated work <br /> f <br />