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( Advanced CHAIN OF CUSTODY RECORD <br /> =< Date -36-Zr Page ) oi_L___ <br /> -- GeoEnwironmental, Inc. <br /> 4005 North Wilson Way-Stockton,Californla-95205-(209)467-1006-Fax(209)467-1118 <br /> ClientVan Project Manager <br /> C b I �er Tests Required <br /> Phone Number <br /> Samplers: (Si nature) h Invoice: <br /> `. r AGE <br /> Project Name <br /> �` Client ❑ <br /> Sample Location Sample Type No. of <br /> Number Description Date Time Water Solid Notes <br /> p Comp. Grab. Air COntS. <br /> �3r11-3b-fib 15Yltt r � laW t4s �{Z� <br /> tf - 1 1c-, X X1 1 ?6tv-av 3, iv r <br /> /13s- k X I .,. I -a I h-00 <br /> - y X <br /> >11 A. oc Doam <br /> e inquis a gnature tgnature DatefTime <br /> Relinquis ed by: (Signature) Received b Si nature I <br /> Y� ( 9 ) � >?atafTime <br /> Relinquished by: (Signature) Received by Mobile laboratory for field analysis:(Signature) DatefTime <br /> Dispatched by: (Signature) DatefTime Received for Laboratory by: f DatefTime <br /> Method of Shipment: Labofalo Name <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br />