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t Advanced CHAIN OF CUSTODY-RECORD <br /> GeoEnvironmental, Inc. -x,63 < ,�, Data��-> pas$ — of1 <br /> 4005 North Wilson Way-Stockton,Califomta-95205-(209)467-1006-Fax(209)40-1118 <br /> Client �' t ` Protect Manager Tests Required <br /> I&I Q VI 7 <br /> Phone Number <br /> (.12<) (o-?- 1 <br /> Samplers (Signature) Invoice <br /> �Y L ��S � ��1�� M& l_ AGE JZ <br /> Project Name �J Client ❑ <br /> T <br /> Sample Location Date Time Water Sample ype Solid No of Notes <br /> Number Description comp arab Air Conts <br /> [ � 1XIk 52570M ri n^ 1�� M I� d� Q 5-St <br /> 041 14—CD e? 019 a> <br /> x k 52572 �— <br /> } <br /> Received nature l7atalTrme <br /> u <br /> 4yi na ey gnature) Recei 5 Date/Trme <br /> Iffile <br /> Relinquished b Si • , rued 6 Jr4obite Laboratory for field analysis SI nature Date/Time <br /> y t FT ,1 DIT1{10th._ APPRP" !/y y y t a } SCIr4 <br /> � I I <br /> Dispatched by (Sig •---�—� Date/Time erve�far Labo�aiory isy !; t]atelTime <br /> V <br /> i <br /> Method of Shipment i La oratory Name <br /> to C-!�Am <br /> /�S�pa,`icial Inslruchons. '_}r 1 hereby authorl a the performance of the above indicated work <br /> p <br />