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rf " !"" r" r'" r1o"" r"IF C�" I—IT rT T t",,' E""" F"'" ["a" f"fr r-11 e�" r <br /> j Advanced CHAIN OF CUSTODY RECORD <br /> ' GeoEnvironmental, Inc. Date-LZZ-OY Page J of <br /> 837 Shaw Road-Stockton, California- 95215- (209)467-1006- Fax (209)467-1118 <br /> Client Project Manager Tests Required <br /> �6 <br /> _. <br /> Phoria Number <br /> LZQ 1 l 140 -(CM, <br /> Samplers: (Signature) Invoice: <br /> Project NameQ ,NI 5 kco �� o AGE <br /> � O��X Clie <br /> Sample Location Sample Typec — <br /> Number Description Date Time Water Solid No. of Notes <br /> Comp. Grab. Air ContS. <br /> 3'3--5 Bvri 3 5' 6'-Zl D`� Klg I 1 1d <br /> 93 -1 D L ion q az i j D <br /> i93 -15 <br /> 03"70 Zp' q 3363 ( `` <br /> 5 C13-7 <br /> f�3'35 @35J q4-1 X X k <br /> Relinquished y: ,gnature ece ve y: ignature Date/Time <br /> un_ [4 " Z2-40 5,3,9 <br /> Relinquis _d by: (Signature) Received by:.(Signature)_. - - - <br /> .__. _ ,_ _ .Date - - . <br /> /Time - <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) 5 r-T 4T Date/Time <br /> Dispatched by: (Signature) - -Date/Time - fleceived"for Laboratory by: f^ - G� Date/Time <br /> Method of Shipment: Laborp y erne <br /> CRi. ©v�tGtir � Ck. TrsH <br /> Special Instructions: I herebyy.authorize the performance <br /> ' /� of the above Indicated work. <br />