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Advanced --- -------CHAIN OF CUSTODY RECORD <br /> � j , []Erl 4 2��-)_ - of <br /> Page �, �— <br /> —_ GeoEn�rironmental, Inc. Date_ \,lt:'�t' � j� �o� <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> Client Project Manager f f Tests Required <br /> 1 MI <br /> Phone Num r <br /> _1 z- <br /> 5amp[ers (Signature) � Invoice <br /> rZ� [ �f AGES <br /> Pra ect Name r Client ❑ <br /> Sample Location pate Time Water Solid Sample <br /> a eple Type So11d No of � Notes <br /> Number Description Comp Grab Air Cants k , <br /> r 40401 <br /> x r. <br /> 40402 <br /> 5- 4i---,LV_� U)Ckr <br /> x x 40403 <br /> 40404 <br /> 40405 <br /> 40406 _ <br /> 1fes. I its Ur 'e, t�. 1 � I �I�lS" >L x x 40407 <br /> elinquks ( = ature) ecewed y tgnature - <br /> 6-i4--t�D <br /> R q (Sigh,t ) {Cih aa9!a r6w m� red Datefrt e <br /> ReIinquts - f�alure Y w tic iv+titYby Motslte tHboratory for held analysis (Signature) Datel7r e r <br /> Orspalch sbrt� +i3halrisa33 tr1,, ,,,M� a llt,3°�Itu,-,�„r, gatelTrme c ved far Laboratory"" <br /> by [` rr,) 1 DatelT me <br /> vL-�U �� � � <br /> Method of Shipment Laboratory Name <br /> 6AL ~ V C° <br /> Special Instfucuons I hereby authorize Phe performance of the above indicated work <br />