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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. ( Date!3-` -65 Page Z of <br /> 837 Shaw Road-Stockton,California-95215-(209)467-1006-Fax(209)467-1118 <br /> ClientProject M ger <br /> g�.lwn r h �} 1`1 �Lo a t"1 ♦��� MOXNates <br /> Phone Number J <br /> `w,t) g6,I- Ino(: <br /> Samplers: (Signature) <br /> Project Name L 2� L <br /> N cs� S i�y-Y� "` <br /> Sample Location Sample Type No. of <br /> p Date Time Water Solid <br /> Number Description comp. Grab. Air Conts. <br /> 14 <br /> ,b-J 2-v k 5 x <br /> 3-g-5 4 3 1 Nq <br /> G-, S-to a r. (p` h54 X t kW <br /> i3 $ lS n �5` i2i5 X i <br /> WaeC <br /> e mquwa a y: ignatme) aoe w Y: ignqure Date/rime <br /> l� L $' f cry iTcC <br /> ehnquishe by: (Signature) Received by: (Signature) Dals/Tima <br /> R <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: ( atura) TDate/Time <br /> 1 -A : l <br /> Dispatched by (Signature) aterrime Received Jor a /story <br /> Laboratory Name <br /> Method of Shipment: <br /> LAi— G4-L_ TECif <br /> I hereby authorize the performance of the above indicated work. <br /> Special instructions: <br />