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t <br /> j Advanced O Q �s I CHAIN OF CUSTODY RECORD <br /> _ GeoEnvironmental, Inc. Q Date R S-cs Page 3 of <br /> 837 Shaw Road-Stockton,California-95215-(209)467-1006• Fax(209)467.1118 <br /> s Project Manager <br /> Client �;SVl Wai w ti 1�( iw�ii�� �M Tests Required <br /> Phone Number <br /> (2cct) q67 -(0bik• <br /> Samplers: (Signature) Invoice: <br /> `� T ' r AGE <br /> Project Name N 2ti✓t�f�F- Si E,r�c c�-�L. cueM ❑ <br /> Sample Type <br /> Sample Location Date Time Water Solid No. of Notes <br /> Number Description Cnmp. Grab. Air corns. <br /> C-_ '5 t I,17V K I ) <br /> B-tg-to W " t4�I$ I <br /> Relinquished y: ignature TW,*Ned y:(Signature) ale/T <br /> cs t4to <br /> Relinquia d by: iSignature) Received by:(Signatur•) T Da /Time <br /> Relinquished by:(Signature) Received by Mobile laboratory lot field analysis:(Signature) 5, I. _ 1 Date/Time <br /> Dispatched by:(Signature) DW {um, Ived ry C3 atornme <br /> 7 Q <br /> Method of Shipment aboratory Name <br /> L <br /> I hereby aulhoriu the performance of the above Indicated work. <br /> Special Instructions: <br />