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!• � � � � � � � � � � � l• 1• �r ilifiiffi� fiiiiiiiiilifil <br /> CHAIN OF CUSTOD RECORD <br /> � Advanced <br /> GeoEnvironmental, Inc. ©ate Page .,.� of <br /> u'� �'�'° 2— <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1005-Fax(209)467 1118 <br /> Project Manager <br /> Client l4 4 u t N M Tests Required <br /> Phone Number <br /> Samplers (Signature) Involce <br /> �`� AGE [)a <br /> tName �{ + 5 oaS '� GMac,aV Client ❑ <br /> Sample Location Sample Type No of b <br /> Date Time Water Solid \'`� Notes <br /> Number Description Comp arab Air Conts <br /> _14 loe' 7q <br /> (P <br /> 9 5 '70 � q 114. I X <br /> e n�q'u s e" y (signature eceive y gnature t"1 f rr,1 y 1 DatelTfine <br /> � 1 "��;"( l't(3[d L1k � ; tl yI ��u �� '1� — "IJ'ar7 (5 I 3{} <br /> Relinquished by (Signature) Received by (Signature) Da elTEme <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatelTime <br /> Dispatched by (Signature) <br /> DatelTime Received for Laboratory by Data/Time <br /> Method of Shipment Laboratory Name <br /> Ou+rvif 4 (1 lP4a <br /> Special instructions t hereby authorize the performance of the above Indicated work <br />