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Advanced 11`0 <br /> w CHAIN OF CUSTODY RECORD <br /> -� <br /> „ GeoEnvlronmental Inc. Date 11 Page Z 01 <br /> of Northem California <br /> 1803 West March Lane, Suite A-Stockton, California-95207-(209)956-0264-Fax(209)956-0700 <br /> Client r Project Manager <br /> Tests Required <br /> 1 <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> Project Name 1 1 IY <br /> 14-T Ag*- <br /> s Client ❑ <br /> Sample Type <br /> Sample Location Date Time Water Solid No. of ;�Iellllls <br /> Number Description comp_ Grab. Air Conts. <br /> �w- 4A �� o A3 - A 3 - l <br /> !1 --Za tt 11, 1 �. [ <br /> :51) --f-` <br /> u r <br /> e inquis ed by: (Signature) Received by: Signature Date/Time <br /> Relinquished by: (Signature) Rec v d t: v- ur f� Date/Time <br /> ?M <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Date/Time <br /> Method of Shipment: Laboratory Name <br /> 4 le 6a <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br />