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Advanced � CHAIN OF CUST <br /> ( A RECORD <br /> _ 1 GeOEnVtt'Ontnental, InC Date �� ��� Page _ of 3 <br /> 4005 North Wilson Way 5locklon California 95205 (209)467-1006 Fax(209)467 1118 <br /> Client Al 1q5 P.-c �ii, 1,+5 Project Manager <br /> Poll Mar 1 Tests Required <br /> Phone Number <br /> 7-01- 46 7- 1006 <br /> Samplers {Signature} Invoice <br /> Protect Name ��w �'t �� ��^op err �'� AGE <br /> Client ❑ <br /> Sample Location Sample Type No <br /> Number DescriptionDate Time Water Air Solid C nts� Nates <br /> Comp Grab <br /> 96903�� <br /> 1 3 5 13� q � X o 96904 <br /> P i 3 : 1t 0 96905 <br /> P 3 - ty y-ov tf , o 96906 <br /> e Inquis eyw ISrgnatdre} ecve y (Signature) �U -! -1Qate/Tilme <br /> fC, 1� QQ3/ +j� l{� <br /> Relinquished by (signature) Received by (Signature) date/Time <br /> Relinquished by (Signalure) Received by Mobile Laboratory for field analysts (Signature) Date/Time <br /> Dispatched by (Signature) Dale/Time Received for Laboratory by Dale/Time <br /> Method of Shipment I <br /> Laboratory Name <br /> �+��'K + rImp �/ PRCSF '!AT10�1 tit�G�tflt ls� [ rr <br /> Special Instructions GOOD CONDITION 01U1 hi <br /> L I hereby authorize the performance o! the above indicated work <br /> V iAINE�S�✓ ��L'''t�'� �V,vu�� <br />