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( Advanced <br /> CHAIN OF CUSTODRECORD <br /> " GeoEnvironmental, Inc. <br /> Date 6t-t5-Vq Page <br /> 837 Shaw Road - Stockton, California-95215- (209) 467-1006 - Fax (209)467-1118 <) <br /> Client7QC i L Project Manager f J <br /> S�ter Tests Required <br /> Phone Number <br /> tUq -Z— LOD(.* <br /> Samplers (Signature) Invoice <br /> Project Name �a, (,,U i Vt M��. �� -� AGE <br /> Client' <br /> Sample Location Sample Type <br /> No of <br /> Date Time Water Solidom Q Notes <br /> Number Description CGrab Air Conts f. <br /> P <br /> �tw��-��^o� IJI�•-� I�5g ?� 3 <br /> 101-t5=c �J 121 3 <br /> Relinquished y (Signature) ecewe y ignalure Date/Time <br /> Relm fished by (Signature) Received by (Signature) DatelTime <br /> Relinquished b (Signature) <br /> q Y ( 9 ) Received by Moble Laboratory for field analysis (Signature) s `� I Date/Time <br /> Dispatched by (Signature) Dale(fime Received for Laboratory by� DaterTime <br /> YkL ---1, 11 - C�q 19 F J <br /> Method of Shipment Labor ryame <br /> Com- T*,Gq <br /> Special Instructions I hereby authorize the performance of the above indicated work <br /> �v� <br />