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j Advanced CHAIN OF CUSTODY RECORE <br /> __- GeoEnvronmental , Inc . c �2f( 5 - C)'364Date �P Z ( ' Page of <br /> 4005 North Wilson Way - Stockton, California - 95205 - (209) 467-1006 - Fax (209) 467-1116 <br /> Project Manager <br /> Client d iifff, C-11'; f* .Sf vLQ� Tests Required <br /> �3iGL C�- <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> Project Name rI 6 S AGE Rr <br /> G?u �G _ •�f �J1 / i1� � r✓ N Client ❑ <br /> Sample Type <br /> Sample Location Date Time Water Solid No. of Notes <br /> Number Description Comp. Grab. Air Conts. <br /> 2? /2 ' <br /> b !14 <br /> e upws e : (Signature ace ve y : ign te/TI a <br /> Relinquished by: (Signeture) Rec rve / y: (Signature) Del /Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Dale/Tfine <br /> Dispatched by: (Signature) DatelTime Received for Laboratory by: Date/Time <br /> Method of Shipment: Laboratory Neme <br /> Special Instructions: I hereby a lhorize the performance of the above Indicated work. <br /> V <br />