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CHAIN OF CUSTODY RECORD N <br /> Advanced <br /> Date 11-22-C21 Page S _ of_ <br /> _ GeoEnvironmental, Inc. <br /> 837 SRaw Road-Stockton,California -95215- (209) 467.1006- Fax (209) 467.1118 <br /> A <br /> F� <br /> Client +Vl �� 1�1� Project Manager ( Tests Required <br /> ®owe �2C� <br /> Phone Number <br /> Samplers: (Signature) O 4 Invoice: <br /> M l9Q AGE °Ati <br /> Project Name G@a p Client ❑ <br /> Sample TypeNo. a` <br /> Sample Location Date Time Water <br /> Solid Corts. � Qiwk� \ Names <br /> Number Description r] Comp. Grab- Ar <br /> YVVW3—� y+awi�or�,sj v,,@U � G st 11 ZZ-is`[ 47.5 X � �fo1� <br /> li�'i3—{s jt It It <br /> fr ii e �1 ,y�o �o�� <br /> M <br /> 0 <br /> LO0 <br /> ll h a 2S' 14 Li n S x x X <br /> o <br /> Daleriime <br /> Sell ms ad y:( rgnatu e) ei:etve y: igne urs - `f / t 5DU <br /> ! - Datelrlme <br /> Relinquished by: (Signa re} Re::eived by: (Signature) l_ <br /> Relinquished by: (Signawra) RecDalafiime <br /> eived by Moblle Laboratory for Held anatyaia:(Signature) <br /> S� l <br /> OateJTime Received or Laboratory Dateyrime <br /> Dispatched by:(Signature) igi {, -(A--9L' <br /> Latory Mam• `� <br /> Method of Shipment: �,2 D <br /> CA� �` M <br /> M <br /> 1 hereby authorize the perlo'r�m�an/({lee off the indicated work. <br /> Spacial Instruckona; !/E��� L V •�-' <br /> _ N <br /> N <br />