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r <br /> i. <br /> Advanced l\6eX1q Ei l-1 i <br /> CHAIN OF CUSTODY RECORD , <br /> GeoEnvironmental Inc. Date to -31 -Y{i Pae IOf <br /> of Northmt Califnrrtirr <br /> 1803 West March Lane,Suite A-Stockton, California.95207-(209)956-0264-Fax(209)956-0700 <br /> ! Client M � , 7 t � r � �! [,�u N�w1 a n Project Manager <br /> Tests Required <br /> M N r 11 i'1 �-��� h�•i r-f <br /> Phone Number <br /> } Samplers: (Signature) Invoice: <br /> Project Name f r"t + A AGE [p <br /> / Client L f <br /> Sample Type <br />! Sample Location No. of <br /> i Date Time Water Solid q / / Notes <br /> Number Description Comp. —Grab. Air Conts. <br />+' A /I0 -3i15 � , � )0 7!-qy I�:y� x 1 1� � 58083 t <br /> i' <br />€ e inquishe y: ( ignaluie) eceive y: (Si atwe DatelTime W <br /> Al l ' I� 1h- -�t3 <br /> Relinquished by: (Signature) Rocoived y: (Sig re) Dala T'me <br /> IU-3+sis j�:4.5 <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Dale/Time <br /> Dispatched by: (Signature) DatelTime Received for Laboratory by: Datellime <br /> Method of Shipment: Labofatory Name T <br /> Special InsUuctions: I hereby authorize the performance of the above indicated wnrk. <br />