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Advanced qaZI4 C, 0\0 G CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date Page ✓tof <br /> ;. of Northern California <br /> 1803 West March Lane,Suite A-Stockton, California-95207-(209)956-0264-Fax(209)956-0700 <br /> Client <br /> STEL n Project Manager Tests Required <br /> C� <br /> B/�6 LSM <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> AwAGE [� <br /> Project Name /� q Client <br /> Sample Location Sample Type No. of <br /> Date Time Water Solid Notes <br /> Number Description Air Conts. I�ts� w <br /> Com Grab. [ice( w ';xn:;rt i, <br /> 24 /45- <br /> 9 <br /> �2— tD <br /> , <br /> —Rel nqu s d y: (Sign Ti ceive y: ( ignatura) �J2� Lt Date/Time <br /> I 1'. M � y / 45--q7 <br /> 7 Saz <br /> Relinquished by: (Signature) Received by: (Signature) 1'(l� ( ' Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Dale/TimeReceived for Laboratory by: Date/Time <br /> Method of Ship t: y� - (' f�AC O�� Ata�boratory Na 11 <br /> Special Instructions: GOODCO�dJITIOPd YW ` uthorize t e performance of the above indicated work. <br /> A('AROPrIATE <br /> HEAD SPACE U IVC � - - <br />