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M = = I= Iii i■r sib- oil iiliiow". <br /> ( Advanced CHAIN OF CUS Y RECOR <br /> GeoEnvi ronmental, Inc. Date 4- r Page <br /> of <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(249)467-1118 <br /> 1 S�/O 7Z �►�G-E' <br /> Client D Project Manager <br /> C.L Cit t� Tests Required <br /> Phone-Number <br /> i <br /> 1 <br /> 1 Samplers: (Signature) <br /> Invoice: <br /> Project Name JC <br /> C> AGE , <br />,j <br /> Client Q <br /> s Sample Location Sample Type i <br /> Numt?er Description nate Time Water Solid ' No. of Notes <br />'i comp. Grab. Alr Corsts. <br /> i <br /> -�D 12 455 <br /> 4 ?� 12456 <br /> i23� x (:2457 <br /> r3 - Uo 1.2455 <br />,. <br /> ZIP k 1.2459 <br /> -�� 2.212460 <br /> k0 J 305 12461 <br /> e m shed y: ( ign ure) ecewe y: tgnature a-yY <br /> � � � uatartimtl <br /> DAR <br /> Re a ed by: ignalu ) Received by: (Signature) Dale(rlme <br /> ' Relinquished by: (Signature) Received by Mobile laboratory for field analysis:(Signature) Datetrime <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Daternme <br /> s, <br />.' <br /> Method of Shipment: <br /> S � Laboratory Name <br /> ynl) O&GI O�� .j� <br /> INAMN <br /> Special Instructions: M � <br /> GUOD ON011ie L <br /> I hereby authorize the perlormance of the above Indicated work. <br /> APPROPRIATE <br /> HEAD PACE ABSD97& C!J11gituirn. <br /> t n tact- b,l Cc J over-n qr <br />