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4rMI <br /> l Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc Date gi Page 2- of�` <br /> of Noithem Calrf(Mna <br /> 1803 West March Lane Suite A Stockton California 95207 (209)956-0264 Fax(209)956-0700 yy� <br /> Client s w( v 5 ) [(� Sc Goo n)`f r,`� Project Manager Tests Required <br /> P,,k Rap <br /> Phone Number <br /> Cjaq 7IF6 - 0).6 <br /> Samplers (Signature) Invoice <br /> Project Name L,ct" m 5 v�tj-( 1�( t,t .� ,,,� AGE <br /> Client ❑ <br /> Sample Location Sample Type <br /> Rate Time No of Notes <br /> i Number Description Water Air Solid Conts , <br /> i Comp Grab <br /> 53032 <br /> 3 -10 <br /> I , <br /> N - 10 0 (J 526534 <br /> [4 0 —F 53035 <br /> t <br /> -1-T <br /> elinquis a by (Si nature) ece vgnature) J <br /> Date/Time <br /> -27-qFfiq!60 <br /> Rolincimshed by (Signature) ed by (Signature) Date/Time <br /> Relinquished by (Signatu(e) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Date/Time <br /> Method of Shipment Laboratory Name <br /> Mewl G4 �� <br /> Special Inslructons I hereby authorize the performance of the above indicated work <br />