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[ t I t [ t f t t t t t [ t t t t t t <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date 8 �17 Y s Pae 3 <br /> 9 —� of <br /> of No,lhml Calijonlia <br /> 1803 West March Lane,Suite A-Stockton, California-95207-(209)956-0264-Fax(209)956-0700 &y _ ,k. f) <br /> Client Project Manager <br /> Y,-e V)�7 M c �l j a Tests Required <br /> Phone Number <br /> j Samplers: (Signature) ��" Invoice: <br /> Project Name ,�tc� �!'^ �'e�^y �1^UC��1 %i9 �1jf�t/ /\ AGE <br /> J Client ❑ <br /> Sample Location Date Time Sample Type <br /> Solid No. of <br /> Number Description Water �y� Notes <br /> comp. crab. Air Conts. <br /> 1� <br /> w � 3 SWCOVKbO �� ' tiro S 1 r 55552 <br /> i-- <br /> S — Z <br /> 60,c-i 'tge,T to ` ►. ��) y- �( 55553 <br /> r ' I'a5T l qP<3 tl 55554 <br /> F 55555 <br /> Relinquished y: (Signature) ec v y: ignatur Date/Time <br /> 7�w��'1�'u ,,�e� ' uc� 5)a ucla v�c( .r��I - � i� s' S'•�y�4� <br /> Reltnquished by: (Signature) f rved by: (Signa re) Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field annlysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Dale/Time Received for Laboratory by: Date/Time <br /> Method of Shipment: Laboratory Name <br /> Special Instructions: <br /> tt�l.�� 1 hereby authorize the performance of the above indicated work. <br /> Con <br /> )c f,1,• <br />