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tttttttttt� �� t_ 1� � � t� i• t� t� � � i• � Si � <br /> I <br /> Advanced CHAIN OF CUSTODOECORD <br /> GeoEnvironmental, Inc. Date `l-16'�J Page -- — of__� <br /> 4005 North Wilson Way-Stockton,Califom,a-95205-(209)467-1006-Fax(209)467-1118 L Z n A&ZpZ c <br /> Client Project Manager 7 <br /> Tests Required <br /> i <br /> Phone Number F, <br /> I <br /> Samplers (Signature) r Invoice <br /> ,_ <br /> Project Name [ 1 it 9 Q Vt-. %1't/6461 AGEQq <br /> Client ❑ <br /> Sample Location Sample Type No of f <br /> Number Description Date Time Water Air Solid Conts <br /> Comp <br /> 5 w lq -1�- �I-13 °I oq '�4p X 1 X <br /> 5wtlq-� 5 10, 00 X <br /> , w -W tmftyn X I <br /> 5W7 I - 15" 4-1q'14 13gO � X <br /> 5wr i -30 IL1S7 K 1 X <br /> 5V/7L I -3 '�1 14=1 " <br /> 5w )?7 -20 <br /> e rnquis e y ( +gnatur ace ved by (Signature) <br /> �Lt.c1 51 +sroo <br /> Relinquished by (Signature) Received by (Signature) Date/Time <br /> _.7 <br /> Relinquished by (Signature) Received by Mobile laboratory or ie d analysis (Signature) DatelTime <br /> Dispatched by (Signature) ��-�- Daie/Trme Received for Laboratory by Dalertime <br /> A4 It-4 131 <br /> Method of Shipment Laboratory Name <br /> F IFS M Caws. bit J <br /> Special Instructions I hereby authorize the performance of the above Indicated work <br />