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q4f cd(06t <br /> r CHAIN OF CUSTODY%CORD <br /> Advanced <br /> � � <br /> GeoEnviron mental, Inc. Date Page of <br /> 4005 North Wilson Way-Stockton,California-95205 (209)467 1006 Fax(209)467-1118 <br /> Client L ccA 1 '.� (C 7e- 1'2 U� Project M��r/- Tests Required <br /> !� Phone Number <br /> Samplers (Signature) Invoice <br /> 1 <br /> Protect Name / _ j% ]� /ZAGE <br /> 16-3 Ciera 0 <br /> Sample location Date Time Sample Type Solid No of Notes <br /> Number Description Water Air Corns <br /> Comp Grab <br /> 56709 <br /> 5 56709 <br /> eit ed y ( i net r ecerve y TC gnature Date/Time <br /> Relinquished by (Signature) Received by (Signature) l /Lt Date/Time <br /> s <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) <br /> Dispatched by (Signature) Date/Time Received for Laboratory by [rrl ^ i �' ite/TTM-e <br /> �4 yr d r - __� i ; , { , , � �r �� �• G <br /> Method of Shipment Abo ator <br /> � y eme <br /> � <br /> Special lnstructions I hereby authorize thl perfothrancii of the above indicated work rir` <br /> lJNC1 � <br /> l�'L J�n1lk4 <br />