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..�� �...■ ..� �.� a.�� rte■ �� � �!! �f E� E� l• F• � <br /> 4r <br /> Advanced rr .i CHAIN OF CUSTODY RECORD <br /> 45V <br /> GeoEnvironmenW, Inc. Date1RPage of <br /> of Northern Calrforrua <br /> 1803 West March Lane,Suite A-Stockton,California-95207-(209)956-0264.Fax(209)956-07oo <br /> Client , Project Manager <br /> Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> + <br /> Project Name AGE= �. <br /> �r��- . •r 2 f,y" Client ❑ <br /> Sample Location Sampiiee Type <br /> Number Description Date Time Water Solid No of Notes <br /> Comp­--6—,;­b Air Conts r– — -- -- ', <br /> _53703 <br /> r <br /> AF <br /> __ _5 3-70 4__�_`t <br /> >m �_ . tr 11 4 _5 370.6 <br /> 6 �tb 53707 <br /> r <br /> PVVLO . 17. <br /> 5 <br /> 53708 <br /> t 1 <br /> f I <br /> Relinquished y ( ignaiure ec v y gnature t <br /> Date,i ime <br /> Relinquished by (Signature) - ad m' &"; 1 - — , r� <br /> ved by (Signature),, <br /> t Date ime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) <br /> Date(Time <br /> i <br /> Dispatched by (Signature) Date/Iime Received for Laboratory by <br /> DatelTime <br /> Method of Shipment ���-�.� Laboratory Name,'fit] r <br /> Special Instructions I hereby authorize the performance of the above Indicated work <br /> } <br /> Go <br /> H�,D S PACS RBSF�VT <br />