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r1 I ! 1 1 t 1 t l 1 1 1 1 I 1 I 1 k I <br /> CHAIN OF CUSTODY RECORD <br /> ( Advanced G,��,p 3 <br /> Date�`L — Page of <br /> - GeoEnvironmentai, Inc.lgg93 <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-11 18 <br /> Client Project Manager Tests Required <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> � AGE 7( <br /> Project Name Client ❑ <br /> Sample Type N <br /> Sample Location Solid No. of / 30916 <br /> Number Descri tion Date Time Water Air Conts. <br /> p Comp. Grab. <br /> '� ..�5' -UU -J-00 115,0 �Ul <br /> md <br /> `6� �CU �( Z'Told 917 <br /> 91S <br /> 919 <br /> _ Dale/Time <br /> Tn inquis a y: ( rgnaturQl f�oerve y: ( rgnature �. `��� STQ )A7' t <br /> Dale/Time <br /> Relinquished by: (Signature) Received by: (Signature) <br /> Dele/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) <br /> Date/Time <br /> Dispatched by: (Signature) <br /> Dale/Time Received for Laboratory by: <br /> Method of Shipment: Laboratory Name ' r <br /> Cr <br /> r , PRESERVATION 7n <br /> Special Instruclio/�ru� PRESERVATION I hereby authorize the perlormff-L- <br /> nc- a ovaIndicated work. <br /> `- <br /> -GOD A <br /> HEAD SPAk ABSENT N _ P1N f*0S�__ <br />