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f• i• �� � ■� � � � � � � � � � s• f• � f• � <br /> � Advanced <br /> • CHAIN OF CUSTODACORD <br /> --_- GeoEnvironmental, Inc Date l6 a5 Page of---52— <br /> 837 Shaw Road - Sto(kion, California- 95215- (209)467-1006 - Fax (209)467-1118 <br /> Client Project Manager <br /> _-,•-� • --•-•�G' I � � Tests Required <br /> Lei 14 V <br /> Phone Number <br /> Samplers (Signature) <c/ Irnatce <br /> AGE <br /> Protect Namer, <br /> CI lie p <br /> Sample Location Solid No of n/ Notes <br /> Number Description Date Time Sample Type Water Air Conts <br /> Comp Grab <br /> Y131-62 X'KX I <br /> Ac7 w- 2 X <br /> d.V_,R <br /> E <br /> e mgws ( <br /> MW- <br /> atur Received by ignature te1Tr <br /> Relinquished by (Signature) Received by (Signature) Daie ime <br /> Relinquished by (Signature) Received by Mobile Laboratory for held analysis (Signature) DatelTrme <br /> Dispatched by (Signature) DatelTrme Received for Laboratory by 1 Date/Time <br /> h--J 7 <br /> Method of Shipment L&7FY Name <br /> ( i hereby authorize the performance of the above in atad work <br /> Special Instructions <br /> F�� <br />