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CHAIN OF CUSTODY RECORD <br /> Advanced Date Pace t1-do of <br /> GeoEnviron mental, Inc. <br /> l 4005 North Wilson Way-Stockton,California 95205-(209)467-1006-Fax(209)467-1116 <br /> Client Project ana er Tests Required <br /> .QVI <br /> Phone Number <br /> 0�w 4 - I <br /> Samplers (Signature) Invoice <br /> AGE N <br /> Project Name 1 i/OLS-e, Client ❑���t'a l���' V� Y1 <br /> Sample Type , Q <br /> Sample Location Date Time Water Solid No of Notes <br /> Number Description Comp r Air Conts <br /> I�-16�-r,.,c�r, ��►�-«� ISI s' � � X ;,����gc?3o _ <br /> cif n5-1�- <br /> i s ignature) eceive by (Signature) D teFTime <br /> -t7` vy 3 <br /> e i he y (Signature) Received by (Signature) DetelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory lot field analysis (Signature) Date/Time <br /> Dispatched by (Signature) DatelTime R�ceiy:ad flaboratory by Date[Time <br /> M thod of Shipment r �, _ Labor`to Name <br /> ' - faun k 4 0 <br /> � ri <br /> n �=r <br /> Spacial InslrucUona ICE/to f hereby authorize the performance of the above Indicated work <br /> i}�LMQ ul'��L�1LuCl1�� CU��lri�i�f�liv <br />