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I • <br /> Advanced CHAIN OF CUSTODYPECORD; <br /> GeoEnviron mental, Inc. Dale — -7ypage Of <br /> 4005 North Wilson Way Stockton,California-95205-(209)467-1006-Fax(209)467-1118 `GAS <br /> Client Project Manager, r Tests Required <br /> Phone Number <br /> 49&ke <br /> Samplers: (Signature) Invoice: <br /> �A � e AGE Q' <br /> Project Name _T A4C-6 r S �� , Client ❑ <br /> Sample Type <br /> Sample Location pate Time Water Solid No. of <br /> Number Description Comp. Grab. Air Conts. <br /> 2� <br /> 5� 2- <br /> 21Z , <br /> e rnqurs a y: Roe a y: rgn re DalelTlme <br /> uc�.. -I! <br /> Relinquished by: (Signature) R ived by: (Sign ure) Date/Time <br /> I <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Dale/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Dole/Time <br /> Method o1 Shipment: Laboralo y Na <br /> C <br /> Special Instructions: I hereby authorize he performance of the above indicated work. <br /> Af VONS 09 1 METALS <br /> G0n0r0t1P'1T1QN 4 - <br /> HEAD SPACE IST_._., <br />