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� �. �� � � � � ,� � � � r>� � lititititill• tt■a. tifiiffil� <br /> • CHAIN OF CUSTODY01CORD <br /> t? Advanced Date —1 r Page _Zii of <br /> -—_ <br /> GeoEnviron mental, Inc <br /> I 4005 North Wilson Way-Stockton,California-95205 (209)467 1006 Fax(209)4671118 <br /> Project Manager-r, /� Tests Required <br /> Client 4 <br /> ' 6 ( 7 Phone Number Gf/ A, <br /> l � a <br /> Samplers (Signature) �� tr Invoice <br />� ! �� �� � �� AGE ,� <br /> /�/� <br /> Project Name C j ��-� ��� Client C]111 � �} � <br /> Sample Type No of <br /> Sample Location Solid ' t Notes <br /> Date Time Water <br /> Number Description Comp Grab Air Conts7-1 <br /> I 31 <br /> 7q rl - <br /> �( \f <br /> 717-11 ;,747-�Y <br /> y ,� <br /> M 7-(6 �y 74- ff N '�0 <br /> 5 <br /> I M 74- f� <br /> 7[1-tf �J-° ' <br /> r Date/Time <br /> ne ecee <br /> r <br /> ILO_4 3130 <br /> DatelTtm <br /> Relinquished by (Signature) Received by {Signature) <br /> Date(Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) <br /> Date[Time eceive for Labor or by Date/Tim <br /> Dispatched by (Signature) <br /> L oratory Name <br /> Method of Shipment r4 Jy <br /> I hereby authorize the performance of the above indicated work <br /> Special Instructions <br /> ver / <br />