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(� Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date 's '2 Page of <br /> 4005 North Wilson Way-Stockton, California-95205-(209)467-1006-Fax(209)467-1118 <br /> Client &147iDti l�L F V-CV=J J.r Project Manager <br /> Tests Required <br /> !P C UELLAV- <br /> Phone Number <br /> 1 <br /> -- Samplers: (Signa ure) y,� �� L <br /> c'' Invoice: <br /> Project Name �ATIa>L[El - ��[C',l� r �'� � �N.� AGE (� <br /> Sample Location Sample Type vv Client ❑ <br /> Number Description <br /> Date Time Water Solid No. of ar -1- <br /> omp, arab. Air Conts. �,� Notes <br /> c <br /> �e *oo 1s: 45274 � <br /> _t'q «• <br /> g atur ) ecerve y: gnature <br /> Date/Time <br /> Relinquished by: (Signature) Received by: (Signature) <br /> Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) — <br /> Data/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory b <br /> atste`/Time <br /> Method of Shipment: <br /> fz <br /> CSL Labora Name <br /> r lJ <br /> _ c�V f�1�( It,�-�i `r '� P1(C4,kipE a- <br /> Speciai Instructions: VDAS O&U �VETALC OTHER I hereby authorize thlor ansa of the above indicated work. <br /> t J OTHER <br /> G�If�DCOTJDITIOtf_ APP€�OPR?A!E �jpar <br /> ; <br />