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�� Advanced CHAIN OF CUSTODY RECORD <br /> Date <br /> d0 Page —L of <br /> GeoEnvir omental, Inc. <br /> : ` <br /> �� �•• 4005 North Wilson Way-Stockton,California-95205-(209)467-10,06-Fax(209)467.1118 <br /> Client / I Project Manager <br /> /j Tests Required <br /> 1',19 8,� Jule"r�i <br /> 01 Phone Number <br /> lac?ve- <br /> Samplers: (Signature) <br /> / 0 30902 <br /> Project Name 1. 0 <br /> .11 <br /> 30903 <br /> Sample Location Sample Type Date Time Water Solid No. of 30904 <br /> Number Description comp. Grab. Air Conts. , <br /> .'vv <br /> i'bi 1<' 5 -60 of <br /> -Ov 3 S" I x <br /> -00 <br /> 6 - ;0-00 Id�S� lid <br /> die in ignatu �eycefrve y: s,buy sig `r�4730905 <br /> e <br /> Relinquished by: (Signature) Received by: (Signature) AfN <br /> 30906 <br /> Relinquished by: (Signature) Received by Mobile Laboratory for lield analysis: (Signature) 30907 <br /> r�J <br /> Dispatched by: (Signature) Dale/Time R Rpceived for Laboratory by: i!1 <br /> 30908 <br /> Method of Shipment: Laboratory Mama <br /> U &c4mbell r1I It <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br /> Imp--- Qf�ESER4'ATIOPI <br /> _.. .__._._._ GOODCONDirinnl _ <br /> HMD SPACrAE�Ei,cT— - rnri,. 5::- = �r <br />