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CHAIN OF QUSTODY RECORD <br /> [ ,7 Advanced Date 10 Page of <br /> --- GeoEnviron mental, Inc <br /> 4005 North Wilson Way Stockton,California 95205-(209)467-1006 Fax(209)467-1118 <br /> Client1 Protect;Manager Tests Required <br /> Phone Number <br /> dZAK <br /> Samplers (Signature) invoice <br /> AGE P <br /> Protect Name � //� � � rJ Client ❑ <br /> Sample Type Y <br /> Sample Location Date Time Water Solid No of Notes <br /> Number Description Comp Grab Air CDntS <br /> TI --01?- ' k <br /> 2 <br /> 7'? - * J— <br /> OS <br /> x R r <br /> L\ <br /> �' <br /> Vv) --C SLID _ <br /> 07 <br /> aRel u,s ( ignatur *iv #(Stgnatule)) <br /> 19 -r to me <br /> Relinquished by (Sig twe) <br /> Rehnqurshed by (Signature) Received by Mobile Laboratory for field analysis (Signature) L1 rye w J Date/Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Date/Time <br /> Method of Shipment Laboralor Name <br /> ^ <br /> Special Instructions I hereby authorize the performance of the above indicated work <br />