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CHAIN OF CUSTODY RECORD <br /> jAdvanced -oV <br /> Date �'_�5 Page � ofd:—_ <br /> GeoEnvironmental, Inc. <br /> CC2) <br /> 837 Shaw Road - Stockton, California- 95215 - (209) 467-1006- Fax (209) 467-1118 <br /> Client Project Manager Tests Required <br /> A-T lift,V1- P✓f G� <br /> Phone Number <br /> 4-t{b � lGD6 / <br /> Sampiers: (Signature) C 1 �4 Invoice: <br /> AGE <br /> Project Name t �iJYI (�ykty, �� V(A'rff r f �/�/1 i' /// Client ❑ <br /> CC `� Sampre Type v V No. of <br /> Sample Location Date Time Water Solid ) / Notes <br /> Number Description Camp. Grab. <br /> Air Cocas. <br /> �6-N,56-�,s -s ��-v� �e-N K5� ��-w �-��-o� � 6 0� � � X �ovh os•f e� <br /> Date me <br /> �elin w (Sign re) ecerve y: ignawre <br /> �""'T /� Y Dal ime <br /> Relinquished by: (Signature) Received by: (Signature) \/ r i <br /> Rsh <br /> elinquied by: (Signature) Ra<eived by Mobile Laboratory for field analysia: (Signature) Dete/Time <br /> Date/Time Re<eived for Laboratory ,F j .7 (' Date rime <br /> Dispatched by: (Signatu,$) a+0. <br /> Labo story Name r <br /> Method of Shipment: .- <br /> I hereby authorize the performance of the above indicated work. <br /> Special Instructions: ^ j ATVGk (,—14,5Tb <br /> /r <br /> i•�/IV <br />