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� i i i i i i w w w w w s w w tititi�w <br /> s s <br /> CHAIN OF CUSTOD ECORD <br /> j Advanced Date Z —t— of�_ <br /> GeoEnv>ironmentai, Inc, U3 Mage <br /> 837 Shaw Road Stockton, California -95215- (209)467 1006- Fax (209) 467 1118 2 ) <br /> I <br /> Project Manager <br /> Client <br /> - �, ry Tests Required <br /> Phone Number <br /> 'Z 1006o, <br /> Samplers (Signature) Invoice <br /> Project Name �4)V � E~►(J '3 �'�yr� !sem C,. Q AGE <br /> Client <br /> Sample Type <br /> Sample Location Date Time Water Solid No of Notes <br /> Number Description Air Conts <br /> Comp arab <br /> S'�r Wr III 3 pf o ti 7� <br /> ,n -S—ii I '\ i <br /> X X <br /> , ) )C I <br /> 2,zi <br /> ora 7y rgnature) Receivedy ignatura Date/Time <br /> u <br /> y o <br /> Rehngwshe by ( rgnature) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for held analysts (Signature) �y Date/Time <br /> Dispatched by (Signature) DatefTime Received for Laboratory y I� DatefTime <br /> 1-4 <br /> Method of Shipment Laboratory Name <br /> tAA r CA <br /> Sptctat kKmiucttons I hereby authorize the performance of the above indicated work <br />