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r r � � �ffifififififfi <br /> t7l <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. c �3 Date 5- ;7_1 Page of <br /> of Northern Cahfonna <br /> 1803 West March Lane, Suite A-Stockton, California 95207-(209)956-0264-t=ax(209)956-0700 76960 <br /> i5 <br /> Project Manager Tests I ct Pr d pY "176961 <br /> Phone Number r <br /> coq ) q 5 6 0),6 <br /> Samplers (Signature) Invoice <br /> AGE ❑ <br /> Project Name )vV-o S7 P ro l pr1l A�1� Client ❑ <br /> Sample Type <br /> Sample Location Date Time Water Solid No of Notes <br /> Number Description --Water <br /> Grab Air Conts <br /> �Aw '1- 30 <br /> MW5 - 36 11 �.�'�1 X a l <br /> e <br /> ifi�fl't1� I <br /> 1pterra I Hwu+ <br /> COD CONDITION!L0 APPROPR TE <br /> -A. <br /> e inqurs ed by (Signature) acarus y ignature Dale[Time <br /> ,da 2z -f7 <br /> Relinquished by (Si nature Received by (Signature) QatelTrme <br /> Relinquished by (Signature) Received by Mobile Laboratory for lield analysis (Signature) i DatetTime <br /> Dispatched by (Signature) DatelTimo Received for Laboralpry by DatetTime <br /> .0 0 <br /> Method of Shipment ({(1() V q— Laboratory Name <br /> A ove✓'r+i �Z w" M1c caws b-Pe <br /> Special Instructions V I hereby authorize the performance of the above Indicated work <br /> A9_1� 1"()a&1 <br />