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t t t t t t t c [ [ e [ [ t t [ t [ t <br /> Advanced CHAIN OF CUSTODY RECORD <br /> I 1 <br /> GeoEnvironmental, Inc. Date -4 Page of <br /> a <br /> 837 Shaw Road- Stockton, California-95215- (209)467-1006- Fax(209)467-1118 �--C) o <br /> Client 1,95 CgrecA Project Manager <br /> `D06 Tests Required <br /> Phone Number') <br /> Iul <br /> Samplers: (Signature) Invoice: <br /> Project Name W ,J+ K.4. 0,44-t;p- AGE <br /> 1C, Client <br /> Sample Location Sample Type <br /> Date Time Water Solid No. ofd <br /> Number Description comp. crab. Air Conts. Notes <br /> ? I—q5 CttcPfbbe Lp qtr to- ' l� °� ( ala <br /> 7'iiv"'✓�"` •r (i(! <br /> Re m uta ad by: ( tgnature) Wecetve y: tgnature <br /> Date/T' e <br /> 61-0 17ZO <br /> i:l <br /> Retinq shed 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) Date/Time Rece' e f Lab story by ate/Time <br /> Method of Shipment: l.�V Af I�'IT Laboratory Name <br /> -- Qr�NI� <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br />