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j Advanced CHAIN OF CUSTODY RECORD <br /> =- ? GeoEnvironmental, Inc. Date JLP-Y$ Page of <br /> ; - <br /> ��r/ <br /> 4005 North Wilson Way Stockton,California•95205-(209)467-1086-Fax(209)467.1118 <br /> l3 x►a sto <br /> Client Project Manager <br /> Dili L i-'7 14 Tests Required i <br /> Phone Number <br /> G'7-Swq - q6'7- <br /> Samplers: <br /> amplers: (Signature) 4 <br /> VOICe: <br /> Project Name M B P -- wa✓y Dr ,V I , %"r 1"16-1, or�5 AG <br /> ,`�,oar 0• Clien CJ <br /> Sample Location Sample Type <br /> Number Description Date Time Water Solid Na, of 7� , ;� <br /> Comp. Grab. Air Conts. �� 'C y l �� F�7 �]'8 <br /> OT 6 �� yl� ta�y�fq Isr� a X X :00779 <br /> t-TK 1 1;1 ;}f�� }�t: ya X 6 XXX 100790 <br /> 5P 'W11, of ttpc1G I+� j6 1 <br /> X X X 007 <br /> 8f <br /> 19 1 X X X1— <br /> W82 <br /> X <br /> T!S $ sx, o;I )art B' t 1 �r 1 X XXT , <br /> I Relinquished by: tbignalut ) ecewe (Signature) <br /> /144 Jl { �` r DalelTime <br /> Relinquished by: (Signature) ��� [`� Uir� I - l��Y� ' 0�) <br /> Received by: (Signature) VIAS <br /> i h FJ� y -- RESERVATION <br /> Relinquished by: (Signature) Received by.Mobile Laboratory for field analysis:(Signature) APPROPRIATE RATE <br /> GOOD CONDITION Dale/rims <br /> Dispatched by: (Signature) Date/Time Received for Laboratory b <br /> Date/Time <br /> lei-K <br /> ea FAI <br /> Method of Shipment: Co Laboratory Name <br /> M�Catri�yil� u v i >r f"(c <br /> IV( <br /> SpecialInstructions: I hereby aut orize the performance of the above Indicated work. <br />