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[ Advanced CHAIN OF CUSTODY RECORD <br /> - ot-4GeoEnvironmental, Inc Date -7 1 bi Page i - 00- <br /> 4005 <br /> 005 North Wilson Way Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> Q Z U�j U <br /> Clienty Project Manager Tests Required <br /> C <br /> Phone Number <br /> Z Ac -y V r�o <br /> Samplers (Signature) Invoice <br /> Project Name � � /� Client <br /> r <br /> 17 <br /> Sample Location Sample Type No of Q <br /> Date Time Water Solid Notes ' <br /> Number Description Air Coats <br /> Comp Grab <br /> V 3 P UQ Pe( �rr4 ick. 11 nn �I l 2- ) 2-1/s x.j 17 r 3 r ` <br /> -z f' <br /> J r <br /> ly <br /> re �` <br /> Relinquished y (Signature) Received rgnalure Date/Time <br /> Relinquished by (Signature) Received by (Signature) I' Da ai me Jf <br /> i <br /> Relinquished by (Signature) Received by Motile Laboratory for field analysis (Signature) Date(rtme <br /> Dispatched by (Signature) Date/Time Received for'labotator by Date/Time <br /> w <br /> Method of Shipment Labors ry Name <br /> 1c R 5 <br /> Special Instructions I hereby authorize the performance of the above indicated work <br /> AD <br /> � I, � � f• � �� ai mer iris � .rte �� <br />