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k <br /> Advanced CHAIN OF CUSTO Y RECORD <br /> GeoEnvironmental, Inc. <br /> Date �a ~3^t Y Page _L of_J_ <br /> Y 4005 North Wilson W ` <br /> o ay-Stockton CaliforniaCaldornia-95205 (209)467 1646-Fax(2D9�4fi7-1118 <br /> Client � ��a a Project Manager 1 <br /> S G� Br II r Tests Required <br /> #70105 Phone Number r -7-10(l 1 O� ti• <br /> f1 � L <br /> Samplers {Signature Invoice <br /> Project Name �� , J AGE <br /> Client ❑ <br /> Sample Location SamDate Time Water ple Type Solid No of ; <br /> Number Description <br /> Comp Grab Air Conts 90061 <br /> r <br /> � <br /> kAk- ( 16 yj-4 1( Lt 90068 ' <br /> Zr C1d ,X U 90069 <br /> r <br /> 90070 <br /> F t <br /> 90071 ` <br /> r <br /> r <br /> �� ✓'S �"3� �Y J(� 1t L 'C 1 91072 ' <br /> e in �_ySig�nat ��� e e y ign Dateliime <br /> L4 g— <br /> Relinquished by (Signature) Rec ved by (Signator Date(Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Dale(Time <br /> Method of Shipment / Laboratory Name Lf <br /> (114 Atl - <br /> C _dT <br /> Special Instructions Vy ON I METALS1 OTHER I hereby authorize the perlormance of the above Indicated work <br /> GOOD CONDITION APPROPRIATE <br /> HEAD SPACE ABSENT CONTAINERS <br />