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wlfffffffr �� f il• � wr <br /> it <br /> j Advanced CHAIN OF CUSTOD RECORD <br /> GeoEnvironmentai, Inc. Date 00 Page M of <br /> 4005 North Wilson Way-Stockton,California-95205 (209)467-1006-Fax(209)467-1118 <br /> Client Too <br /> Project Manager <br /> 0-r Tests Required <br /> Phone Number <br /> Lou t w <br /> Samplers (Signature) Invoice <br /> Project Name1 l _ AGE k', [ lb,-A � A4&tvt Client ❑ <br /> Sample Location Sample Type 9 <br /> Number Description Date Time Water Air Solid C ntsNo f �� Notes <br /> Comp Grab <br /> C - Or Ll-11-00 SO 0 X <br /> 35860 <br /> ✓L -T 3 01 4 -11 35861 <br /> ✓ -�' �A W y - 35862 - <br /> 7 ��I-ov t7OV <br /> 35863 - <br /> ✓C.4 UJ - )0 to -I1-00 300 3 <br /> 35864 - <br /> �L�� 35865 <br /> ✓tc.PT - q-11- oo OV ,� � 358fi6 <br /> _�m"q^ a ( ignature Roc vs y ignatur /— r <br /> uV 1' F `T (�� 5TH S de'� .TA i OalelTrme <br /> 10 <br /> Relinquished by (Signature) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) gatelT+meReceived for Laboratory by UatelTime <br /> Method of Shipment Laboratory Hama <br /> C � €le� � YOAMW <br /> Special Instructions I+CEIR PRESERVATION 4 f ereby authorize the performance of the above indicated work <br /> n <br /> `L <br /> DEAD SPACE.ASSENT CONTAINEiL. ._ Utl <br /> J <br /> �- <br />