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i <br /> M 3 <br /> CHAIN OF CUSTOD RECORD <br /> I Advanced -� -.� � Date �2 •zk 3 Page <br /> GeoEnvironmental, Inc. <br /> 837 Shaw Road-Stockton, California-95215- (209)467-1006-Fax (209)467-1116 <br /> Client Lj ��-�- 1� Pro Manager Tests Required <br /> P one Number <br /> hone <br /> q�7—t� � q <br /> Samplers (Signature) Invoice <br /> AGE <br /> Project Name OCCL� 'CaC� s�L�� � Client ❑ <br /> loo <br /> Sample Location Date Time Sample Type Solid No of `v 'L ' l�/ Notes <br /> Wat <br /> Number Description ptian camp Grab Air Conts <br /> }} V I/ <br /> l 12 Zw a3 �� <br /> Relinquialiou 157 qsi a e Received y ignature Qate/Tlm <br /> �Z 26 Gf con <br /> Reltnqutshed by (Signature) Received by (Signature) Date/time <br /> Relinquished by (Signature) Received by Mobile Laboratory for held analysis (Signature) <br /> Date/Time <br /> Dispatched by (Signature) Date/Time Received borat ry by Dale/Time <br /> Method of Shipment Laboratory Name col —� C <br /> CCJ c� d-V\ <br /> Instructions <br /> Special �� r �� I hereby authorize the performance of the above indicated work <br /> p frac is <br />