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i <br /> ( Advanced CHAIN OF CUSTODY RECORD <br /> --- GeoEnv>ronmental Inc. Date 1 z! » 2- <br /> : - Page Of <br /> 837 Shaw Road- Stockton, California - 95215 - (209) 467-1006 Fax (209)467-1118 <br /> Client Y � ( .y Pr jest Manager <br /> 'T � Tests Required <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> Project Name r , AGI=. <br /> r6 M c. <br /> Client ❑ <br /> Sample Location Sample Type <br /> Number Description Date Time Water Solid No. of q� <br /> Air Coats. Notes <br /> Gr <br /> Comp. ab. c� J <br /> _.�' • Izrya., t�� - zt 1ct3 D4J �-- r <br /> - UUt)CO btTr <br /> TF,ADSPA EA]-sLN AP <br /> RO <br /> T D IN LA SER &D ���p <br /> TtGS1.Rw 1 Vp p ALS p �""'�" <br /> inquis e ( ignature} eceive y; Egnature <br /> G <br /> DatelTime <br /> elinquished by; (Signature) ILI ze_`' /Gc1�: <br /> Received by; (Signature) Date/Time <br /> Relinquished by; (Signature) Received by Mobile laboratory for field analysis: (Signature) / <br /> i <br /> Dispatched by. (Signature) (late/Time Re i e r laboratory y: ~ <br /> 1 .DalelTime Z r v� <br /> Method of Shipment: La D t}r�attory hla �e ;4W <br /> /)S'' j/I <br /> Special tnstruotions: �� + <br /> ! hereb autho..zeVhe performance of the above indicated work. <br /> D& INT�I�T VIA � ��� <br />