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Advanced CHAIN OF CUSTODY RECOR <br /> Date �?�--2'1-tt Page f of GeoEnvlronmental, Inc �p� !f <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-4116 <br /> Pr sect Manager <br /> Client Tests Required <br /> ��- <br /> Phone Number <br /> C2i) 'w_�z- f b <br /> Samplers (Signature) Invoice <br /> Protect Name � 11 <br /> l � Client <br /> � <br /> F ! ❑ <br /> 'C� <br /> Sample Location Sample Type Date Time Water Solid No of �� � Notes <br /> Number Description Comp Grab Air Coats <br /> 59690 <br /> 59691 k <br /> 1t5s- 59692 �r <br /> t� � 1a� 59693 - <br /> �~ _ <br /> -5-969A - <br /> f <br /> 59695 <br /> - 59696 09 <br /> x - <br /> Mby__'(SS_-9- <br /> ature Receivedy tura Uatel f ime <br /> UOAS �tI "I" OTHER Z-7-o ► 9'-n <br /> 2,,ftdature) Received )Pf fM IV OatafTime <br /> ^ =�iY'n rr �•,i1 <br /> Rehnquished by (Signature) �r eceived b �f�„L�iporatory r fieid analysis (Signature) DatelTime <br /> KAD SAGE ArdSt 5 Ar <br /> Dispatched by (Signature) Date(fime ekooked 1cw i_aboratoryby r datelTime <br /> Meth d of pment i Laboratory Name <br /> �. r Imo__IL_ (-( `'l / <br /> Special Instructions J I hereby authorize She oerformance of the above indicated work <br />