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- <br /> CHAIN OF CUSTODY RECORD <br /> Advanced Date 12 2tff Page L- ofd <br /> GeoEnvironmental, Inc. r -c f-if'L 445 : <br /> 4005 North Wilson Way-Stockton.California-95205-(209)467.1446•Fax(209)467-111 a <br /> Project Manager,- Tests Required <br /> Client �• fb,�v (; , -Tt'J <br /> Phone Number <br /> fh <br /> Samplers: (Signature) (Z' r , Invoice: <br /> v GE <br /> `tom C' <br /> Project Name <br /> Sample Type No. of Notes <br /> Sample Location Date Time Water Solid Conts. <br /> Number Description Comp. Grab. Air <br /> f 3 X 00771 <br /> Date/Time <br /> nature) ecerved y: ( r nature <br /> e�nqurs ed y: { ig p <br /> o CA . WAS 0&G lv��t Qil'iER <br /> q (signature) Received by: (Signature) • � . T`�yl,' <br /> elin uished by: ( 9 ) h1� . L PRESERVATION <br /> 11JLj��Rr ate ime <br /> Relinquished by: (Signature) Received by Mobile Labora ory for lield analysis: (signature) qCU G4JI1SUiTjI�IV APROPRIATE <br /> ,LA 11 V 11S`U I �V IYI.t�� pateMme <br /> l)atelTime Received for Laboratory by }� I �� <br /> pispatched by: (Signature) <br /> R :17D <br /> Laboratory Name <br /> „k Method of Shipment: <br /> I hereby authorize the performance of the above indicated work. <br /> Special Instructions: ! ] c <br />