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M i i i i i i i _i i <br /> • ! • <br /> Advanced (� � , `� CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date_ / ��` _ Page C of <br /> 4005 North Wilson Way Stockton,Califom€a-95205-(209)467 1006-Fax(209)467-1118 <br /> Client � � � ect Manager Tests Required <br /> L Sb,J <br /> Phone Number ! <br /> Zoy - )6 e) <br /> n Samplers (Sign tune) � � Invoice <br /> Project Name AGE'-] <br /> Client ❑ <br /> Sample Location Sample Type <br /> Date Time No of <br /> Number Description Water Sohd <br /> Air Conts F Notes <br /> Comp Grab � <br /> 513-46 ' t-5- rB JD 1/15--00 9 '17 X C X �( 53617 <br /> kZ8 ib 3 2, 53619 <br /> 15-13-1b- 3L. <br /> Z 1 x 53620 <br /> 163-lo - 3-? 12,by x 1 53621 <br /> L'53-lb h 46 1 rS 7 X, 1 - <br /> r 53622 <br /> fSj'�11 - /S— ( 6( 12 Yom ( <br /> u e y gnature eceive y ignature <br /> 53623 <br /> i <br /> Relinquished by {Skgnature) Received by (Signature)nature)Sl S—FA_ <br /> Dat /Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatelTime <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Date/Time <br /> ` 1L� C/ 4 z Gt <br /> !- c C, r �6 <br /> Method of Shipment .,. _ _ _ _ Laboratory Name <br /> CAL U t VQAS MG!11.7410711M <br /> Special Instructions Mrnn};,1711 11 <br /> her euthoriie the perfor ante of the above Indicated work <br />