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a � <br /> Advanced CHAIN OF CUSTODY RECORD <br /> _ GeoEnvzronmentalInc. -1 --� z r <br /> � Date 6 g <br /> y Page of�_ <br /> of Nonhem Califorma <br /> e i 1803 West March Lane,Suite A-Stockton, California-95207-(209)956-0264-Fax(209)9560700 <br /> {{ <br /> Client ar�►t+�an'�S�Th�s S Project Manager <br /> fob Ka r T V Tests Required <br /> I <br /> Phone Number <br /> (coq ) QS6 -o.2 �q o <br /> ` t IT <br /> Samplers (Signature) �`' °e <br /> p { 9 ) � invoice <br /> Project Name G Lt a S-P L -C VP o Nl,ad 15 0 � iLL�/t�(, � tc``�,`�` h• AGE <br /> !r1 Q Client p <br /> Sample Location Sample Type <br /> Number Description Date Time Water Solid No of Dr, �fi -L ao� Notes <br /> comp Grab Air Con <br /> bPq -�-�]� �aitK01 W45 � U -t6-gi 13100 x l 11 S 5:J07 <br /> T(Z g, IL C.2 rL! t r 13- t <br /> Y, X x , <br /> P� -�0 x 2-- K XXX X '�'�� <br /> G P q o�- X x 53510 <br /> Wf( fib - 2o 535 <br /> ` <br /> It 15+0 ~ X K x X X' �r 5-3512 f <br /> 1� <br /> �P 7 - 7 iNor��\ 5 -513f <br /> k i <br /> Relinquished y (5ign;[ure) Yed <br /> y igna re <br /> r r a_ r <br /> mate ro���d <br /> 4S I6 04 <br /> Relinquished by (Signature) y (Sign lure) <br /> DatelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for held analysis (Signature) <br /> Date/Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory by <br />` DatelTime <br /> othod of Shipment -� Laboratory Name <br /> '¢- J 1 + 191/k/1 <br /> Special instructions <br /> nn rrrry I hereby authorize [tie performance of the above Indicated work <br /> 10E,T <br /> 1 IKUX � <br /> H r,3 S1' CMSENT <br />