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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date * 1 Page Z of � <br /> of Northern California m <br /> 1803 West Marnh Lane,Suite A-Stockton,California-95207-(209)956.0264- Fax(209)956-0700 m <br /> Client Project Manager <br /> C I Tests Required <br /> U1 <br /> Phone Number / °1 <br /> Samplers: (Signature) Invoice: m <br /> Lo <br /> Ari= d <br /> Project Name k / Client 0 <br /> Number <br /> Location Date Time Water Sample Typeer Solid No. of � / Notes <br /> umber Description Air Conts. <br /> comp. Grate. <br /> VZ--�c� et t —o C21 <br /> D <br /> 71 <br /> to <br /> 173-- 5; 2. L? <br /> elinq;is ed hy: (Sign re) ReceivQd y: {Signature) rate(Ttme . <br /> uisuish � �+ -7 79-0b <br /> Relin <br /> 9 y: (Signature) Received by: (Sign u ) Date(Time <br /> Relinquished by:(Signalure) Received by Mobile Laboratory for field analysis: (Signature) Oate(Time <br /> Dispatched hy: (Signature) Date(Time Received for Laboratory by: DateFrime <br /> Method of Shipment: Laboratory Name rrww J -0 <br /> 0f) Sf 79, �.l.� S-,DI <br /> M <br /> Special lnstruclions: 1 hereby authorize the perlorrnance of the above indicated work. <br /> N <br /> p <br />