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r - r c tc r 1r r c c c r <br /> E <br /> Advanced CHAIN OF CUSTODY RECORD <br /> Date71-13' 00 Pae ^ <br /> --_ GeoEnvironmental Inc. 9 — of <br /> , <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1116 <br /> ClientProject Manager <br /> �� G ��, O r t �4A Tests Required <br /> Phone Number <br /> Samplers: (Signature) ��r invoice: <br /> . � <br /> Project Name AGE & <br /> Client ❑ <br /> Sample Type <br /> Sample Location Date Time Water Solid No. of 429,F9 <br /> Number Description Air Conts. <br /> Comp. Grab. <br /> -All <br /> 42960 <br /> V9 3 `{ 4296 <br /> 42962 <br /> 9 S I `2 023 42963 <br /> 42964 <br /> AL 42965 <br /> 1419 <br /> el nquls y: ( ignatureReceived y: (Signature) Dale/Time <br /> Ralinquish d by: (Signatu s) Received by: (Signature) DatelTime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) Date/Time <br /> Dispatched by: (Signature) DatelTime Received for Laboratory by: Data/Time <br /> Method of Shipmen O <br /> Special Instructions: VUtt� n9tC t I hereby authorize the performance of the above indicated work. <br /> . -, L}I <br /> W , r.i <br /> i <br /> l411Li�Llt <br />