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M M M M M M Mw =1 M M r ■■r mow■ N15� M <br /> Advanced cur q0`6 CHAIN OF CUSTODY RECORD <br /> GeoEnviron mental Inc. <br /> Date y Page of <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> Client 6 -CV <br /> Project Manager <br /> U h S Ur I L; Va Tests Required <br /> q5----O 5 Phone Number I a� <br /> qj 7- <br /> Samplers: (Signature) Invoice: <br /> Project Name AGE <br /> Client ❑ <br /> r <br /> Sample Type , <br /> Sample Location Date Time Water Solid No. of Notes <br /> Number Description Air Conts. aF.` .w� ; y <br /> Comp. Grab. u` � ' <br /> /4 _1 -YX 7-6 ,XI 3. <br /> L4 - 7— [ 12;1 <br /> Rel'in uis ad by, (sign at e) oe a ive y: i ature Qs1e�Time <br /> y� 0 3 Sid aril Y- <br /> Relinquished by: (Signature) ceived by: (Si ature) Qate/fime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) QalelTime <br /> Dispatched by: (Signalure) Dale/Time Received for Laboratory by. DatelTime <br /> Method of Shipment: L Laboratory Name J /�� Vr'rN i � � CQ N'I �G /i 4�, <br /> Special Instructions. WAS ON9 METAi.J !1T[3 1 hereby suthodle the pertorman a of the above indicated work. <br /> t hh <br /> 01AIG 1 L� <br /> 7C V <br />