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AM <br /> ASC. CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date <br /> l page <br /> t� - O <br /> 4005 North Wilson Way-Stockton,California-95205-(209)4fi7-1 DQfi-Fax(209) 7-�f 18 <br /> Client _ ® Proj ct Lager <br /> Tests Required <br /> Phone Number <br /> ,Samp)ers: (signature - <br /> Project Name <br /> a AGE <br /> Client <br /> Sample Location Sample Type <br /> ❑ <br /> Date Time No. of <br /> Number Description Water Air Solid Notes <br /> Comp. Grab. Corfu <br /> = 46255 <br /> Vol S°L G dal OTHER <br /> AP Uig (� <br /> IN S E CG, TAI >RS <br /> ups y: ig tura ecetve y: ignatme <br /> j Qale/Time' <br /> eii ad by: TionawAT Received by: (Signature) <br /> Data/Tlme. <br /> Relinquished by: (Signature) Received by Mobile Laboratory For field analysis:(Signature) <br /> • �.� Da4elTime <br /> Dispatched by: (Signature) Date/Tlme R calved fcr Laborator by: <br /> r� Date/Time <br /> Method of 5hlpmanC �:• [ <br /> Laboratory Name <br /> ea <br /> Speci Instructions; <br /> I hereby authorize the p rformanca of the above indicated work. <br />