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CHAIN OF CUSTODAECORD <br /> Advanced Date 17Z�f'age --�- of �Z <br /> GeoEnvironmental, Inc. <br /> 837 Shaw Road - Stockton, California- 95215- (209)467 1606 Fax (209) 467-1118 j <br /> Client Pr ect Manager Tests Required <br /> ed V,- l c L <br /> P one Nuim r <br /> Samplers (Signature) /VAG <br /> ke <br /> / E <br /> Protect Name /fi, �/ nt ❑ <br /> % � / <br /> Sample Location SampieType Solid No of ��� �!�// Notes <br /> Date Time Water / <br /> Number Description Comp Grab Air ContsXXX X1 <br />�ILJ 2zr Nll.� ' - Z 2Z 2 <br /> PAW 3 X200 <br /> X1 <br />�lh) I►.) 4LI a <br /> XY � <br /> � M <br />� t 3� Data rine <br /> elinq es e y ( ign ure) ecewe y rgnature <br /> Relinquished by (Signature) Received by (Signature) �1 Datefrime <br /> Rei�nquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) �'� AI— DatelTtme <br /> dispatched by (signature) Datef ime Received for Laboratory by Q) Datefrime <br /> i U/-1--l� )2.- L -R -r q <br /> Method of Shipment Laboratory Na <br /> Lr Pw��c` CSC <br /> � � f I hereby authorize the performance of the above indicated work <br /> Spacial Instructions <br /> 4e!!bF <br />