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• i <br /> l <br /> Advanced CHAIN OF CUSTODY RECORD <br /> - GeoEnvironmental, Inc. Date y Page 1 ot__�___ <br /> C( I <br /> ;, <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1116 1q ry 3 r <br /> ! r _J fS C <br /> Client V i } � .kJ qh Z n R Project Manager Tests Required <br /> 1 <br /> Phone Number <br /> Za - - <br /> Samplers (Signature) invoice. <br /> Project Name AGE�-- <br /> �— Clier ❑ <br /> Sample Location Sample Type No of �� <br /> Number Description Date Time Water Solid Air Gants Nates <br /> Comp Grab <br /> So rl VG jaa r � )r l r c,�7rn^ I Tt0jo i <br /> 34957 <br /> So ,1 vaQn/Z '�x�rac.�,p � S t <br /> �i 34958 <br /> i <br /> e <br /> i quis e y ignature} eceivy rgnature Datefrime <br /> elei , Ak(w fo a�� T�9 N o 4 R U � 1 a <br /> Relinquished by { n tura} Received by (Signature) batefTim <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) BatelTime <br /> Dispatched by (Signature) Datelrime Received for Laboratory by DatelTlme <br /> Method of Shipment Laboratory Name <br /> _ (-'AL_JAI<� ,� r CL � 1 <br /> Lc C, <br /> Special Instructions VOaS I 0&G I METALS OTHER i hereby authorize the performance of the a6ove'maicateh work <br /> r I <br /> GOOD CONPITION I � <br /> HEAD SPACE ABSEW CONTAINERS ., � <br />