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Advanced tI� �� CHAIN OF CUSTODYI RECORD <br /> 'r v Date 5 L' 1�/ Pa / f � <br /> GeoEnvironmentai, Inc. Page o <br /> 4005 North Wilson Way-Stockton,Califomia-95205-(209)467-1006-Fax(209)467-1118 <br /> Project Manager <br /> Client Tests Required <br /> Ct <br /> Phone-Number <br /> Samplers: (Signature) - <br /> ` ` � AGE [� <br /> Project Name NA '6, Ky ZY, (�ol� Co��i�?s Y�'�t(':,l c( r'�'I r�rtL <br /> � Client ❑ <br /> Sample Location Solld Notes <br /> Sample Type No. of <br /> Number Descri tion Date Time Water Air Conts. i���� <br /> p comp. crab. t_1 A.�bc� ! -()04 <br /> J <br /> MW <br /> - r .3•DS '�,y / c t <br /> Ax I INAW <br /> q <br /> e inq isled natureReceived y: (Signature) Date/Time <br /> , ti "� �'C —fp-�q 5:�S <br /> R linquishe by: (Signature) Received by: (Signature) Date/Ti e <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Receiv for Lab ratory by: DatelTime <br /> r 9 d <br /> Method of Ship]n,�'�' <br /> �- Laboratory Na <br /> )���:P����. 'IJ r ��, x I�1A �,i cls. <br /> Special Instructions: ] j l hereby aulhori a the performance of the above indicated work. <br /> • rr r r r r rr r� rr r rr rr rr r rr Ir r rr ■r rr <br />