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l t t [ [ t t [ t I t [ L t t t t <br /> ( Advanced a 0s 5Q?j • �Q�j <br /> CHAIN OF CUSTODY RECORD. <br /> 4 Xa�� <br /> Date �/ 13 Page <br /> GeoEnvironmental, Inc. <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467.1118 <br /> ClientProject Manager <br /> c t�.. M Tests Required <br /> r+ <br /> Phon Number ° <br /> Samplers: (Signature) dory Z Invoice: <br /> h � . AGE IM <br /> Project Name / �r Client <br /> Sample Location Sample Type No.of <br /> Number Description Date Time Water Air Solid Conts. Notes <br /> f_ Comp. Grab. <br /> �;49 k x <br /> at3o x K k VX <br /> I a30 Y, x x X — <br /> B_ i05} K K k. _ <br /> It yy < Vt X <br /> I115 1 x x X <br /> e i ups a gnat a eceive y: ignature "oAc I1g�G �I�ql <br /> N AS U p� . <br /> �C�n,l!TI�, L/ <br /> elinquishe y. (Signature) Received by: (Signature) r� <br /> f'.�.._ti I%T i) -•� ate ime <br /> Air(; .....� <br /> Relinquished by: (Signature) Received by Mobile Laboratory for liel pt . <br /> � Date/Time <br /> WE AD SPA t.°`t ��, ,:'< ,w <br /> Dispatched by: (Signature) Date/Time Re eived for Labo at y by: ,/ Date/Time <br /> - (ym / 22- <br /> Method of Shipment: f Laboratory Name <br /> CA 0y-ttwAW%4 k4o. UCeMlMcCALAp6oXo cA <br /> Special Instructions: fs I V I hereby aut orize the 6erformance of the above Indicated work <br /> JAC <br /> a <br /> L• W <br />