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Vl- <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc . Date Z` Y Page J of� <br /> ' 4005 North Wilson Way - Stockton, California - 95205 - (209) 467-1006 - Fax (209) 467-1116I ��s ` ..D I O <br /> Client Project Manager 1�f <br /> fMC 'Ift^ f CokJ f/r , Tim / � / ate Tests Required <br /> Phone Number 'r l L, p <br /> q6 7 <br /> Samplers: (Signature) e` Invoice,:, <br /> ACBE 4 <br /> Project Name NU ►� ell1i COhs1r- � \ � , Client E <br /> Sample Location Sample Type No, of <br /> Number Description Date Time Water Air Solid Conts. I` Notes <br /> Comp. Grab. <br /> WAS U&G MI: AIS UTHER <br /> PRER <br /> (I. <br /> GOOD CONDITiOlt V A <br /> FPRO i;UITE <br /> e R Vie.) cahA nie <br /> (Stgnat re Received y: ignalure 2ale/ri e <br /> Relinquished by: (Signature) Received by: (Signature) Daternme <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/time <br /> Dispatched by: (Signature) Dalelltme Recei a for,�aboralory b : Date/rime <br /> a VZ- 9 <br /> Method of Shipment: ' Laboratory Name <br /> Ga I DvC�yi ) % 9kMc <br /> S ecial Inslructio , 1 hereby authorize the performa rce of the above indicated woN� ` <br /> p — f TOF ff �e fec fel. e, �J Cah � V <br /> W / 6264 M , � e1fi 1 ; #n4 f rnuf f be fOwr olYI') <br /> � Nevn I ppm . <br />