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- <br /> [ C Advanced I CHAIN OF CUSTOD( IECORD <br /> GeoEnviron mental, Inc. <br /> Date 3"3rd-� Page --q:— of�_ <br /> 4005 North Wilson Way-Stockton,Calilomia-952{)5-(209)467-1006; Fax(209)467-111• �Lf <br /> Client Project Manager <br /> FL/ � Tests Required <br /> Phone Number <br /> Samplers:^(Signature) Invoice: <br /> � „ }sal /, A� AGE , <br /> Project Name (lV{,Yjfit U1.J:1 Client ❑ <br /> Sample Location Date Time Sample Type Solid No. of Notes <br /> Number Description Water <br /> p Comp. Grab. Air Cants. 08269 <br /> 08270 <br /> Relinquished y: ( ignature) ecew y: I Dale(Time <br /> !✓ J ' V�/+r �G� <br /> Relinquished by: (Signature) Recei d by: (Signa ure) � �� DatelTime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for lield analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: DaleJTims <br /> Method of Ship en y /� Laboralo. ry Name <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br /> WAS I O&G I METALS OTHER <br /> BEAD SPACE ABSENT CONTAINERS_[. - <br />