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—� �� �..�ri tititir� t� tt� � � � � I• � � �� � <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvzronmental, Inc. <br /> of Nnrtll`071 Caltfoinia Date 6- R' `� Page I Of <br /> 1803 West March Lane Suite A Stockton California 95207 (209)956-0264 Fax(209)956-0700 <br /> Client L-q tkl y,y�,�f 5c(noir( 57>^P Lr Project Manager <br /> �0� }trty- Tests Required <br /> Phone Number <br /> 7-oq? 't5' 6- 0ff-6y <br /> Samplers (Signature) � Invoice <br /> Project Name t"-QV 5 V I [ f � ' 9 -st-G �� AGE <br /> Client E]Sam le Location Sample Ty- <br /> Number <br /> Description Date Time Water Solid No of �� �� NotPe <br /> Comp Grab Air Con I i <br /> i I <br /> 5 �6 `� <br /> P [ 7 Nw pl,064 � i5 f5 6 t <br /> X I X X <br /> P z 7 C,tti7r4 5027 <br /> I X � r <br /> P 3 - 7 X X t; 5329 <br /> 1 ] F_as T 1 Li -o0 X X } 3n <br /> � r <br /> _ T i 5 3V r <br /> �u s7- No�Y h f � ` 3 0 �' � X � i , <br /> e inquis ed by (Sign lure) e y ign p <br /> Tli 'T Date Time <br /> Relinquished by (Signature) ' �� G ddA`"� 6 1Q Q��UrQ� <br /> eived by (Signature) Date/Time <br /> It <br /> Relinquished by (Signature) Received by Mobile Labor ry for field analysis (Signature) <br /> Date/Time <br /> Dispalched by (Signature) Date/Time Received for Laboratory by <br /> Date/Time <br /> Method of �Ipmenl � � /ff Laboratory Name <br /> Special Instructions <br /> t^�f^• r hereby authorize the performance of the above Indicated work <br /> �r 11 <br /> ��f }t1Y,lr Zvi <br /> J - <br /> 0"p-4— <br /> or- <br />