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� � � � � � � � � I• � f1111ff� tlfttttt. �. .... <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. <br /> Date �'�t-7(0 Page Z of- — <br /> 837 Shaw Road-Stockton, California-95215-(209)467-1006- Fax (209)467-1118 06 16 <br /> q <br /> Client - Project Manager Tests Required <br /> I one Number n� <br /> Samplers (Signature) ' Irnrofce <br /> Project Name rU � QAGE <br /> pro <br /> j -� Q--� <br /> . Client ❑ <br /> Sample location Sample Type Date Time Water Solid NO ,�f Notes <br /> Number Description Comp crab Ali Cont s a �ij �!I <br /> I <br /> L 1 l(Q X- <br /> tr1& L cg4 z ' x X- <br /> u 5° ek ?� rd <br /> oNw aA) \JQ kZp. k O-2,Z <br /> e\ <br /> an rs e yReceived y ignatute Date(Time <br /> Lcc7i-1C`t-! <br /> Relinquished by (Signature) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) 1 P\— Date[Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory b ��14 Date/Trme <br /> Method of Shipment k � Lab ry NamenN k� <br /> Special instructions C I here thorrze the per ce of the bone Indicated work ' <br />