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[ t t I t t t t t t [ [ [ [ t t t [ t <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date `6`17-q� Page — of <br /> .' <br /> ;•� � of Narnccm Gtlifrmtin <br /> 1803 West March Lane,Suite A-Stockton, California-95207-(209)956-0264-Fax 209 956-0700 <br /> Client Project Manager <br /> 14 C K-,bi,4 h Tests Required <br /> Phone Number <br /> .z0"0 c75 s-0,), 6 N <br /> Samplers: (Signature) 1��' Invoice: <br /> Project Name L <br /> ProjI / / �\ <br /> f 1 r«1 � � �1�t k, �'ru C��i�ttir �U►'t'�ti AGE�/Zu1`'U'(v>!✓'� � Client �f <br /> a <br /> Sample Location Date Time Sample TypeWaterSolid No. of �y� Notes <br /> . <br /> Number Description Air Cents �� , <br /> Comp. Grab. f r <br /> 1 Sr do-1 s'1a�1�,�� ��'WNN' I )T3d . 5562 <br /> t , <br /> 5 - <br /> 5J' ( -3I I I <br /> ' 55563 r <br /> Relinquished y:lip (Signatur ) ve y: r ature <br /> � Da)J' t � 4$ . �n ' T w A Date/Time <br /> �� /`f Da y'pro.AvtU <br /> Relinquished by: (Signature) ceived by ( rgnalure) { <br /> Dale/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Timo Received for Laboratory by: Date/Time <br /> Method of Shipment: Laboratory Name <br /> � C� l .e <br /> Special Instructions: y�pr t tr r^*, - .i <br /> P �LThI �t,t` .� ,� , I hereby authorize the performance of the above indicated work. <br />