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El Advanced <br /> CHAIN OF CUSTODY RECORD <br /> :- GeoEt�vi1 ontl�ental 1IIC. Date <br /> �r (ir _� n Nrnlhrrlifrrr�tia Pae <br /> 1&]3 West March Lane, Suite A-Stockton, California -95207-(209)956-0264- Fax (209)956-0700 <br /> i <br /> Client C� _ �, a � Project Manager <br /> 70 -- ------- .— -- Tests Required <br /> Prone Number <br /> 17- <br /> Samplers: <br /> Samplers: (Signature) Invoice: <br /> Project Name r L"J / <br /> A G E t;3f <br /> Client rJ <br /> Sample Location Sample Type t �/ <br /> Date Time �u 7 -/ Notes <br /> Number Description D _ Water Air <br /> Conts. `5 solid No. of <br /> // // / <br /> Comp. Grab. , ; ; <br /> /0:10 <br /> -- -- ✓ 56586 <br /> q.,L6 56587 <br /> 56568 <br /> 56596 <br /> rt 56591 <br /> - igsileiVic lr stcd by: (S _ iigatnre �C 56592 <br /> F,ci+rryuislin+sltr.d by: (Signahrrc) H rued by: (Signaturef <br /> Daleltirnr. <br /> I,ciinquishrtl 6y: (i i[nature) F,eceived by Mobile Labnratgry for licltl annlysi.^,; (Signature) -- — <br /> DafefTime <br /> Dis,raiched by; (Signature) Ua,e/Tirrre received loo Laboratory by <br /> Date/rime <br /> tdel od of Shipment: 1 <br /> Lai ioorator Name — <br /> Special Instiuctiods; <br /> t trereby authdrize tha perlgrmance of Fhe above indicated work. <br /> i <br />