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I Advanced �� CHAIN OF CUSTODY RECORD <br /> GeoEnvlronmental, Inc. <br /> Date oo page —j— of <br /> 4005 North Wilson Way-Stockton,California-95205 (209)467-1006 Fax(209)467 1118 <br />� <br /> Client <br /> e�1'Z!n5^ crr Project Manager <br /> P Tests Required <br /> Phone Number <br /> Love. <br /> Samplers (Signature) t\ 1� <br /> Project Name � Invoice <br /> 0 AGE a <br /> fid"' ❑ <br /> Sample Location Sample Type ' <br /> Number Description Date Time Water Solid No of Client <br /> /�� <br /> Comp crate Air Conts Notes <br /> � s <br /> r w fc�1 L) I } <br /> b )- 30 <br /> g - <br /> e inqu s e y ( ign ture t l� <br /> eceive y ignature <br /> WHO "Ti�� <br /> Relinq shed by {Signature} 'YL t t )oy Date/Time <br /> Received by (Signature) <br /> Relinquished by (Signature} <br /> Date/Time <br /> Received by Mobtie Laboratory for field analysts (Signature) <br /> Dispatched by (Signature) <br /> Data/Tama Received fvr Laboratory by Date/Time <br /> Date/Time <br /> Method of Shipment � �I,�7y <br /> VQAC Ove rn� 'N Laboratory Na a <br /> Special Instructions <br /> I hereby authors the performance the above indicated work <br /> !i"llfl'� (��! Y� _ ( �� (51 :�I50 F, i'r�l <br /> 2 0 <br /> rirttrr -""'fir trrnr�- __:: t� >_ ttttttttttts Sam r_ t� ttttttt� t>_ �� t� �� tf� ti■ri <br />