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,, Advanced CHAIN OF CUSTODY RECORD <br /> -' - f-�U Pa � of <br /> 18� 9 3 Date s � 9s <br /> GeoEnvironmental, Inc. <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> Client _ Project Manager <br /> Tests Required <br /> _ n��_....._Tt�yc, i, � — RC2r <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> Project Name <br /> an+i 30909 <br /> t <br /> Sample Type H <br /> Sample Location Date Time Water Solid No. of 30910 <br /> Number Description Air Conts. t <br /> Comp. Grab. <br /> .-- <br /> oo _ 1x35 x X X 30911 <br /> nq!� x 30912 <br /> P2 - 3o' - - U los x x x <br /> (�3 -5` <br /> �Relinquished y: ( rgnature) _ nature <br /> _ r / .5 TO AT <br /> 1 30913 <br /> Relinquished by: (Sig ature) Received by: (Signature) " 30914 <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) 1 30915 <br /> Dispatched by: (Signature) Dale171me Received for Laboratory by: <br /> Method of Shipment: Laboralofy Name <br /> r <br /> O <br /> ern G(c'!A e a /C <br /> Special Instruction's: I hereby aulhorize the performance of the &wove Indlcaled work. <br /> t VRVATION <br /> GOOD CONDITION-le `' <br />