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• CHAIN OF CUSTODY ECORD <br /> � Advanced ,�. <br /> GeoEny><ronmental, Inc. Date9. _/L_&1_ ase Z- of <br /> 4005 North Wilson Way Stockton,California-95205 (209)467 1006-Fax(209)467-1118 <br /> Client K6 4c Project!anger Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> CJr AGE <br /> Project Name �I J � � Client ❑ <br /> Sample Location Sample Type No of <br /> Date Time Water Solid / Notes <br /> Number Description comp crab Air Conts <br /> 5 <br /> i <br /> e I �re y ignat ece ve y ignatura DalerTime <br /> r� <br /> Rahngwshe by (Signature) Received by (Signature) <br /> / 'Dv fIl-A'0 7 Date/Trme <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signatur i DatelTime <br /> Dispatched by (Signature) Date(Time c ved Or Lab tato y by Date/Time <br /> Method of Shipment boralory Name <br /> vaRS n �� , T�1S aTt�E Xk -r <br /> Special Instructions t�'-i + __r i hereby authorize the performance of the above indicated work 1 <br /> JL <br /> lr, 0f_. _ Caiirl <br /> �_ , titin runt lti• r� � � P �r 1t+! ? <br />