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w■ ltd ■� jjjjjjjjj� jjjjjjjjj� jI• M MM M <br /> AdvancedCHAIN OF CUSTOD)kCORD <br /> p <br /> GeoEnvironmental, Inc. <br /> Date `3 f Page � of f U <br /> 4005 North Wilson Way Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> Client Project Manager <br /> 1�4 k4 i KM (- �r �'h�h Tests Required <br /> Phone Number <br /> �to <br /> Samplers (Signature) e� Invoice <br /> Project Name L va (�R� �`ruC jai 5)o() "�"� 'j/tJr�� '� AGE 1K <br /> 4 h Client ❑ <br /> Sample LocationSample Type No of <br /> Number Description Date Time Water ACt <br /> Air SolidNo <br /> �� <br /> q Comp Grab 22550 , <br /> XYI 1 22551 <br /> n 22552 <br /> RAZ ^ } ` 1 I. l l X <br /> $ 22553 <br /> )1-T <br /> -T -) 0 <br /> Fi )-I - LAO l i : 3� 22554 <br /> 22555 <br /> r ' <br /> 22556 } <br /> r <br /> e ingws e y ( ignature Received y Signature Dalerme <br /> -� -rl?� r /4-t <br /> `Wr� q-301121[6-30— <br /> Relinquished by (Signature) Recery d by (Signatu Dale/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Date/Time <br /> Method of Shipment Laboratory Name <br /> M (cgr i-it[ I <br /> Special InstructionsvUAS ON METALSVTNIII 1 hereby authorize the performance of the above Indicated work <br /> GOOD CONDITION APPROPRIATE <br />