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M 0111111111111 � � i• i• <br /> ( Advanced CHAIN OF CUSTODY RECORD <br /> _ = GeoEnvironmental, Inc. Date 3(cel Page ---L of <br /> 837 Shaw Road - Stockton, California- 95215-(209)467-1006- Fax (209)467-1118 <br /> Client Project Manag r Tests Required <br /> P one lumber <br /> Samplers (Signature) Invoice <br /> Project Naml AGE <br /> Name <br /> CV'erokee Client ❑ <br /> Sample Location Sample Type No of <br /> Number Description �- Date Time Water Ar Solid Cants Notes <br /> Comp Grab <br /> r Z ccs t,� 'Z 3�y ��' LA x <br /> diS2- X X <br /> i / y <br /> 4,, 34Y l X( �g�r eci <br /> y ign ata e <br /> Relinquished by (Signature) Received y (Signature) Date ime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) -�- r.�- Datelrime <br /> Dispatched by (Signature) 1CWDate i e JH*;=P;�I; <br /> foratory by [[\\ 1 Dataf ime <br /> GCOD CONiDITION <br /> Method of ShipmentDECHLORMATED IN LAB----?RESERVED IN Laboratory Name <br /> b trey Iii ` vaws I oao I gats I OTE C� Qom( <br /> Spacial knstructiona <br /> 1 hereby authofize the perform ce of the above indicat d work <br /> L <br /> REC'D SEALED & INTACT VIA ti <br />