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IMM MM M MM MII• MM =1 M M MM M <br /> rr Advanced CHAIN OF CUSTOAECORD <br /> GeoEnvironmental, Inc Date 2" "3 -0D Page --L of 3 <br /> 4005 North Wilson Way-Stockton California 95205 (209)467 1006-Fax(209)467 1119 �r � T22 lac_ <br /> Client Project Manager <br /> K w ?h M `lei,Wtvk Tests Required <br /> Phone Number <br /> 10q , tib 7- loot <br /> Samplers (Signatur@) `� Invoice <br /> Project Name (-�a.5x G�l��y�fll>< � - MdGli5t71,� t �� �� AGE [ <br /> Client <br /> Sample Type <br /> Sample Location Date Time No of <br /> Number Description Water Air Solid Conts ��R�` Notes <br /> Comp Grab � � <br /> * � w- I /7- ��-o0 �.-�-oo z t : �c� <br /> � � � 30794 <br /> 4- MW-),I�- -00 to- i� x 5� 30795 <br /> 4 MW .q -Uc) t �.o� X y X 30796 <br /> �+ MW _ _0a, 10;Ltd 30797 <br /> MW-i, b 30798 <br /> 30799 <br /> +Mw -GIN/1 -00 0800 <br /> e mV e ytgnatr`e ace e , Y ie Date%T�im 3 — <br /> Relinquished by (Signature) Re eived by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) bate/Time Received for Laboratory by Date/Time <br /> Method of Shipment <br /> VA Laboratory Name <br /> CA ov4,,h, kj <br /> M t- <br /> lr t <br /> Special Instructions I hereby authorize the performance of the above Indicated work <br /> GOOD CONDITION APPROPRIATE JG4,� <br /> BEAD SPACE ABSENT--V— CQNTAINERS <br /> . wI-V <br />