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� � � � r �- fi, � � � i• � � lllllll� � <br /> I <br /> Advanced CHAIN OF CUSTODY RECORD <br /> --- ,"- GeoEnvironmental, Inc. Zgaq� 74 hyo -, Date Page �_ of z <br /> 837 Shaw Road- Stockton, Callfornla-85215- (208)467-1006-Fax t)gi 467-1118 <br /> Client , Project Manager <br /> [,v t Tests Required <br /> &L 6-L,=W <br /> Phone Number f <br /> rl�a <br /> Samplers: (Signature) Invoice: <br /> Project Name AGE f'Client <br /> Sample Location Samp e ye No. of <br /> Date TimeWater Solid <br /> Number Description comp. crab. Air Conts. <br /> -- <br /> �w3 <br /> 13y0 <br /> / 21 <br /> r <br /> 84128 <br /> - <br /> e m s e y: (Signature' <br /> Received y: gnature uai@I IIme <br /> 7 <br /> eyes [,et:r <br /> Re uiahed . (Sl na r 1 Received by: (Signature) DateRlme <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) patalTime <br /> Dispatched by: (Signature) Date(Time Rece ve for Laboratory by; / ate/Time <br /> Method of Shipment: VO S I,.1ETALS OTH[fi Lalrorstoty Name <br /> u`G i� `` c6E4 GIL <br /> Special Instructions: I hereb orize the p rfielibe of the above indicated work, 1 <br /> GOOD CONDITION <br /> REAUSFATEABSEN <br />