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t <br /> Advanced CHAIN OF CUSTODY RECORD <br /> ` �-+g-d e <br /> GeoEnvironmental Inc. Date 3 Pag of�- <br /> 4005 North Wilson Way,Stockton,Gatifornia-95205-(209)467-1008-Fax(209)467-1118 <br /> :tient Project Manager �. <br /> C S `. ' r c}y Tests Required <br /> Phone Number \ <br /> Samplers (Signature) Invaice; <br /> / AGE 5k <br /> 'roject Name �� Client <br /> R <br /> Samo a Type <br /> Sample Location No.of �` Notes <br /> Comp. G►ab. <br /> Number Description bate Time Water Air Solid Conts. <br /> �E4c�H t_z�� . <br /> L Z- %-14-03 0%-C) X Z- Y, X <br /> L- Z 1015 <br /> LL-3 Jo35 <br /> OI to A <br /> LL-5 1105 <br /> -(o � ►a� <br /> LL' l 114?- <br /> llaterri a <br /> e ur y: ignature Receivedy: gnalure Last 1pC4 ay or- g-11-v3 <br /> 1�03� <br /> rnquishad by:(signature) Received by:(Signature) Mo.d`...y �Se Date/Tlme <br /> Relinquished by:(Signaluro) Received by Mobile laboratory for field analysis: (Signature) 1 Dale(Time <br /> 01spalchad by:(Signature) Datefrime Rserved for Lab oratory by: D •Rime <br /> .Method of Shipment: Laboratory Name Ca k O\1 er n ' CCA T c. <br /> 4Special instrucliens: {- 1 here y authorize the DerrOrOlanCB of the above Indicsted work. <br /> rTDf SeC CO „+\ C ' F Vv A%ic <br />