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F <br /> t Advanced CHAIN OF CUSTOD RECORD <br /> GeoEnvironmentai, Inc. Date o �z � LPage 3 o I±� <br /> 837 Shaw Road-Stockton,California-95215-(209) 467-1006 Fax (209) 467-1118 I <br /> F I <br /> I ' <br /> Client 13 K�'o Project Manager <br /> ► '� 7 V�111,)A Tests Required <br /> Phone Number <br /> fico y ' 7 - foo <br /> Samplers (Signature) invoice <br /> Project Name AGE�_[�< <br /> T. C /r, Client Cl <br /> Sample Location Sample Type No of A <br /> Description Date Time Water Air Solid <br /> 'v v ` <br /> Number Descrl Notes �I <br /> Comp Grab /� <br /> u r 1 t3 r`Jr�r' P u A y qnp L 9 � <br /> '�� +� ` 3 c�rlf�.r• <br /> 47- 3u FT AS(j (it Q <br /> r" <br /> tr R` SrF !3 b -Z1-41 <br /> ,t T , 05 01-Z0,41,L] ; �( <br /> T I T 65 Lr- Q <br /> fir It <br /> 4S PT 05G- 01-70 a4 17-'rZD � wi <br /> rt ! r fr tt <br /> y - � aX <br /> t t rci r-T QS(,, Iw����4 <br /> r -9 , � P- <br /> Relinquishedy rgnature ecewe y rgnaturs Date/Time <br /> -7v'" `7` jl�zl,at y; 3q� <br /> Relmqurshed by (Signature) Received by (Signature) DatafT[me <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (5lgnature) DatetTime <br /> Dispatched by (Signature) Date/Time Re Laboratory D e iaa If <br /> Method of ShipmentCILEAnyib <br /> Laborat Name <br /> C f�j i <br /> C� <br /> Special instructions I hereby authorize the performance of the above indicated work <br /> r <br /> ' I� <br />