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CHAIN OF CUSTODm C <br /> Advanced ORD <br /> t <br /> GeoEnviron mental, Inc. Date -Dc� Page of <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> Client � w � M Project Manager � � Tests Required <br /> Phone Number <br /> Zot V O i <br /> Samplers: (Signature) Invoice: <br /> i <br /> AGE* <br /> Project Name it L Client ❑ <br /> Sample Type,`- <br /> Sample Location Date Time Water Solid No. of Notes <br /> Number Description Comp, Grab. AIC Cants. <br /> M4n��-s�r;nG� b.�Cll tif: . Z � �RR55 <br /> Ni bVo�-LI5 5os 1 5 <br /> (). 35 S <br /> 27 <br /> At <br /> r z_ -f,r� �1 ' If 5 �G L-&6 ** *13— <br /> F , , I, <br /> I�Jyr t, rr t5 FSE Z- -r ', Zo S <br />�V v"0`1- Q t 4 52 3 PAC, <br /> t, <br /> el <br /> rr ,t � ?5 <br /> Le qurs a y: ( ,gnature) ece,ve y:--§ignature) Date/Time <br /> 1 prnf <br /> Date/Time <br /> Relinquished by: (Signature) Received by: (Signature) <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) DatelTime <br /> Dispatched by: (Signature) Date/Time Re ve o Laboratory by: Dale/Time ` <br /> �• 7� ( 5 <br /> Laborat ry Name <br /> Method of Shipment: <br /> CA t <br /> Special Instructions: I hereby authorize the performance of the abov6 indicated work. <br />