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� � � f� � f� � �. i• i• � i• ir)• � i• i• fi f� i• <br /> I Advanced CHAIN OF CUSTODY RECO D <br /> GeoEnvironmental, Inc. Date 14 Pageof <br /> 837 Shaw Road • Stockton, California-95215- (209)467-1006-Fax (209)467-1118 o6 <br /> Client VEL ' Pr 'act Man r <br /> w�y�. Tests Required <br /> Phopq Number <br /> Samplers: (Signature) c , Invoice: <br /> -P &01�-Q ,YIJL:'V- — AGE <br /> Project Name -A Client ❑ <br /> Sample Location Sample Type No of - r <br /> Date Time {Nater Solid ti Notes <br /> Number ❑eSCCI�t10n Comp. arab. Air � 5 <br /> Vp r blqjo-; /6/4) X 3 1� <br /> 2-3 -3 T 'Y <br /> 1317 -! a 13441 <br /> 3 7C x <br /> ,617-2- <br /> 7- <br /> 617-Zz v .1 els 3 <br /> e inquis a y: ignature ecerve y: ignature Date[Tin e <br /> epllc /63o <br /> Relinquished by: (Signature) Received by: (Signature) DateJTime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) Date rime <br /> Dispatched by: (Signature) Date/time Received for Laborator _l � Date/Tim <br /> L( <br /> Method of Shipment: aboratory Name <br /> Q Wrr` GA L --T-a C 4` Llt f' $ <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br />