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Advanced CHAIN OF CUSTODY RECORD <br /> Date 3-Of- Page L of <br /> GeoEnvironmental, Inc. ��} <br /> 837 Shaw Road• Stockton.California-95215-(209)467-1006- Fax(209)467-1118 <br /> Client Project Manager Tests Required <br /> Phone Number <br /> uzoq) `t L, ' -t ci (a• <br /> Samplers: (Signature) C Invoice: <br /> Project Name t •. . C �l• �• ��`11 x'�h �nt p <br /> Sample Location Date Time Sample Type Solid No. of �� j Notes <br /> mp. <br /> Number Description CoGrab. Air Corns. fit° <br /> lb 'L -tom X5-2 L lS' �-3 e5 Olt- <br /> $ 2 2� p� 7 e zc Ic A X 1 }old <br /> 3-2 K F (� <br /> �• -s 3c ,rsrs x j 4D 14 <br /> 6 S`(t q t ler 11 3I K 1AVt4 <br /> 11 57- <br /> j w\ <br /> Refinqwshady: ,gnalure) eoe w Y: prulure OWlime <br /> Ralirp aMd Dy: 1 ignahne) Received by: (SignalwaDae) T Dat /Tims <br /> e <br /> e/Tim <br /> Relinquished by: (Signature Received by Mobile Laboratory for field analys' .( gnature) <br /> �� - � I l • <br /> Dispatched by:(Signatws) Date/time Race ed r bore /, ate/Tk�• <br /> � : <br /> Method of Shipment: Laboratory Name ' <br /> Special lnstructwna: $2140 Yt4 5e&" -": ov.� Cw<: 1�opcop.,l V& r 75�O�1ntx.t) 0.1Cctr(�•`1 I hereby authorize the performance of the above indicated work. <br /> J aLck. via � a 4q `4t,• <br /> iv�S 't t'e.� w. ( 'C <br /> sair v�v l�S�S .J�-ir_ a - ictlola. <br />