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Advanced CHAINF CUSTODY RECORD <br /> (rk (0 Date P17 U Page of <br /> GeoEnvironmental, Inc ` <br /> 837 Shaw Road - Stockton, Callfornia-95215 (209) 467-1006- Fax (209) 467 1118 <br /> Client Pr fa Ma g Tests Required <br /> i.C� <br /> nr <br /> V t- <br /> hone N ber <br /> 0 'tuyL <br /> Saa (SI tura) Invoice <br /> Project Name AGE Er' <br /> d Client E] <br /> Sample Location Sample Type No of i <br /> Number of Description pate Time Water Air Solid Conts 'b Notes <br /> Comp Grab <br /> Z <br /> Z-17-0 JJ1 7/dT Z, <br /> '7 <br /> M f/2-17 ( 1D ► <br /> 4 7-- � <br /> e inqu Sh nature Received 6y g at re ? I fJ tslrime <br /> '117 <br /> Relrnq she by (Signature) Received by ( rgnature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date(Time <br /> <��AA7- <br /> Drspatched by (Signature) flalelTime Received for Laboratory by DatelTime <br /> Method of Shipment Laboratory ama <br /> / � I <br /> Special InstructionsP rr ICER I hereby n t rite t erformanee of the above Indicated work <br /> 1 (GOOD CONDITIONAPPROPRIATE <br /> E <br /> I1EAD SPACE ABSENT CONTAINERS r <br /> ^� ED IN LAB PRESERVED IN I ABL 91c2:: <br /> RECD SEALED& INTACT VIA U vp�ya� a&a I t�reTnLs orrg <br /> i <br />