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i 0 <br /> ( Advanced CHAIN OF CUSTOD ECQRU <br /> ==a GeoEnvironmental, Inc Dateul- Page --�± of <br /> 837 Shaw Road - Stockton, California- 95215 - (209) 467 1006- Fax (209) 467-1118 <br /> Client �� <br /> ' Project Manager <br /> j�(�� ���� Tuts Required <br /> Phone Nu ber <br /> QCC 4—t <br /> Samplers (Srgnature) � <br /> Invoice <br /> / AGE <br /> Project Name =��t � C BVI ,� �L / / Client ❑ <br /> Sample Type <br /> Sample Location Solid Na of � r/ � Nates <br /> Gump Grab <br /> Number Description Date Time Water Air Conts <br /> ,AW G�b Iv ILO V-3-C) ILA <br /> i <br /> LJ <br /> 6c,:'I - � _-- <br /> inq)ished y Signa e) ecB+ve y +gnature Date/1+me <br /> Relmquished by (Signa UM Received by (Signature) Date/Time <br /> ICfat° y-� <br /> a s <br /> Reltinqu+shed by (Signature) HEAD SnAGEAASEI�T Recelvetd��pl� a rY for field analysts (Signature) (� Dete/T+me <br /> DECHLORINA F-D IN i.A 3 PRESERVED IN LAR <br /> Dispatched by (Signature) PRFSFRVATIQN a Received for Laboratory b .- -D A Date/TEme <br /> G � -- <br /> Method of Shipment Labarato y H me 41 Ak} <br /> Special Instructions -- 1 her uthorize the performs ca of the above indicated work <br /> Z " 4c5 lEC'D SEALED & JMMIA <br />