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qa6 c� �;a°11 � �°� <br /> Advanced y g CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date Page Z of <br /> of Northern California <br /> 1803 West March Lane, Suite A-Stockton, California-95207-(209)956-0264-Fax(209)956-0700 <br /> Client Pro'ect Manage <br /> Tests Required <br /> Phones[Number <br /> Samplers: (Signature) ` Invoice: <br /> Project Name AGE <br /> G <br /> Adat�a& Client Ci <br /> Sample Location Sample Type No. of <br /> Number Descri tion Date Time Water Solid Notes <br /> p Com Grab. Air Conts. <br /> ' <br /> P• , <br /> ��� ►C7 eye} s.. ye,. „:a <br /> 40 <br /> cv> WA <br /> x <br /> o inquis y: (Signal re ecetve y: ( ignature 20'�1� tj1 �'�ll Date/Time �L� <br /> Relinquished by: (Signature) Received by: (Signature) �• YY o� ' h�•. i` '�,t^'� <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) <br /> Dispatched by: (Signature) Date/Timo Received for Laboratory by: Date/Time <br /> Method of Shipment: Ir, ;rr.r7;✓ •"•r , " '� Laboratory Nie / <br /> WAS 0& METALS OTHE C /L <br /> Special Instructions; -1 hereby authorize he performance of the above indicated work. <br /> GOOD CONDITION APP110PRIATE , <br /> SPACEHEAD N T_4jovCONIAINERS <br />