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� Advanced <br /> CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date $ page �_ of <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> Project Manager Client � g Tests Required ' <br /> K eV�iv1 ��Ki � <br /> Phone Number <br /> �,q67- cook <br /> Samplers (Signature) InvoiceAGE <br /> ` <br /> Project Name C y ct r hi t'5 pay* V I'Te,, 4,f Client <br /> CI ent ❑ <br /> Sample location Solid Sample Type No of a <br /> Number Description Date Time Water Air Conts Notes <br /> Comp Grab t� <br /> L <br /> r <br /> 4 - ),S - $Nqv X <br /> B4 -30 <br /> 54 <br /> � 5' -}yT w <br /> Relinquished y ( ignatum, Rec d by turF 1��(� - Date/T me <br /> Relinquished by ( +gnature) Received b (Signature i 1 Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for held analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Date/Time <br /> Method of Shipment C Laboratory �'; <br /> pV'r+ti �Tl <br /> Special Instructions I hereby authorize the <br /> perform-puce of the above indicated work <br /> � r• � i ■�! �■� r_ � i■ - Ir■rtr IIIttIttlTtl\ � r � � .... <br />