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• 0 <br /> Advanced CHAIN OF CUSTODY RECORD <br /> Geoftvironmental, Inc. 3LU31-z( G q Q C Date Page or <br /> 4005 North Wilson Way-Stockton,California-95205-(209)487-1008-Fax(209)487-1118 <br /> Client Project Manager Tests Required <br /> 4 14IJ <br /> Phone Number �► <br /> Samplers (Signature) 64 Invoice <br /> Project Name C� � AGAGEs, l.��v Iia��{` -- U tin h urtn - s Client ❑ <br /> !r <br /> Sample Location Solid Sample Type No of <br /> Number Description Date Time Water Air Conts 4 Notes <br /> 1161- Comp Grab <br /> 10, 10 <br /> 5:11-06 <br /> - <br /> M OYrl'4 D <br /> I�It 'jo W - <br /> d a S-jr-r, 13t4t5 <br /> 1llli: _j,_oo s=I I-Do -- <br /> ��-Is-1 -IV&D 15f j tr) 3F�Z.a <br /> Ing ignalure Received y gnatura <br /> D e/Time <br /> 5I'lvbV, • '. 0 300 <br /> e by (Signature) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date(Time <br /> Dispatched by (Signature) Date/Time Received for 4boratory y S DatelTime <br /> -00 <br /> Method of Shipment Lab story Name <br /> 1�-(JJ er�J I a V M IL c v Mi Jq <br /> Special lnstructfons - nr�r yip h� t f hereby authorize the performance of the above Indicated work <br /> ICEIRr 4`v'(M�, vV`�L/ <br />