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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. �( �-f g � Date Page � of <br /> 4005 North Wilson Way-Stockton,Callfomia-95205-(208)467-1046-Fax 9)467-1118 <br /> #sent Project Manager <br /> Tests Required <br /> Phone Number y <br /> Z422-) J10 -166 6 � <br /> Samplers. (Signature) U Invoice <br /> 'ra}ect Name �6 G, ry ���,pn) 641-117 /�� rile AGS <br /> 1,17 F-� �! � �1 C`I1ant f'3 <br /> Sample Location Sample Type No of ' 69938 <br /> s <br /> Number Description Date Time Water Air Solid Conts 11 <br /> Comp Grab } � <br /> ` 9939 <br /> E <br /> t <br /> 69941 it <br /> �?W 2 Q3 IX <br /> 69942 <br /> 69943 <br /> ` 69944 <br /> 1 <br /> Relingiffilhed bV'( gnatufe Received y (Signature) Data/Ttme <br /> Relmqutshed by (Sign U(b) Received by (Signature) DatelTima <br /> .! t <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory b f„ Date/Time <br /> f! i IS <br /> Method of Shipment Labora ory Name <br /> PAL 624060: AA ,BELL <br /> Special Instructions I hereby a horize the performance of the above Indicated work <br /> e <br />