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� � rr rr r� rr r rr r rf r rr rr rr rr r �r r� <br /> Advanced CHAIN OF CUSTODAECORD <br /> - -�=�- GeoEnvironmentalInc. Plv /,2•9" <br /> Date Page 1— of�— <br /> qf Northern Cufifon:ia <br /> 1803 West March Lane,Suite A-Stockton, California-95207-(209)956.0264-Fax(209)956-0740 <br /> Client ✓ r C� Project Manager <br /> & Tests Required <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> Project Name AGE <br /> r�� S IV(,46aL� Client ❑ <br /> Sample Location Sample Type No. of <br /> Number Description Date Time Water Solid Notes <br /> Comp. Grab. Air Conts. <br /> 5. <br /> r <br /> el�ng4+s I Lee by: (Signature) Received y: ( ig- ature) t7atefTime <br /> RelinquishedVol <br /> '_by: (Signature) ��j ed by; (Signa[ re) <br /> �[f� / (� l'Z —`l' Date/Time <br /> Relinquished by: Signa[ur Received7b 'til)el-aboratoryfor field anal sis: Si mature Y (Signature)) DatelTime <br /> Dispatched by: (Signature) a e/Time Received for Laboratory by: Date/Time <br /> l 2--ZZ�-�i SI�q-� <br /> Method of pment: Laboratory Name <br /> [t� <br /> Spacial Instructions: 1 hereby authorize the performance of the above indicated work. <br />