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r rte■ rr rr rr ■r r r■■ rl M. r y�ir <br /> Ad ,vanced Z • CHAIN OF CUSTOD*ECORD <br /> j � ,c� <br /> '~ GeoEnvironmental, Inc. <br /> Date -L 1- 1 Page � .' <br /> 4005 North Wilson Way-Stockton,California-.95205-(209)467.1006-Fax(209)467-1118 <br /> ClientProject Manager .,.�� . <br /> - R" � � ,e T Tests Required <br /> Phone Number 1 <br /> Samplers: (Signature) f Invoice: <br /> Project Name - AG <br /> Client ❑ <br /> I i m�- 0a 1>~ Sample Type <br /> Sample •Location No. of <br /> Number Description �'� � Water Solid `s Notes <br /> p Comp. Grab. Air COnts. <br /> .pq ,15 ori +, f � <br /> -} - Y,zo 't l Sl <br /> p� ,2 05h on k z RF+a <br /> (iAT E5 RKI 8 y�3 <br /> 5 <br /> P 3.0. <br /> 4 -:`aa.. 4.y <br /> e qus a y: ( ig t re ecerve y: ignature Dale/Time <br /> T <br />� ki_?3Y9 yr p <br /> Relinquished by: (Signature) Received by: (Signature) Date(Time <br /> Relinquished by:.(Signature) Received by Mobile Laboratory for Geld analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time eceive for Laborator by: Date/Time <br /> Method of Shipment: r La oratory haAe 7 kAydy-� )'N <br /> Special Instructions: I hereby authorize the performanc4a of theabove indicated work. <br /> ij <br /> is <br />