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i � � r• O � � � >, � � I• � � r I• �� I_ <br /> l <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmentai, Inc <br /> Date 5-e'_7'7 Page of <br /> 4005 North Wilson Way-Stockton,California 95205 (209)467-1006 Fax(209)467-1118 <br /> Client Project Manager _ <br /> ��i; /�� est L172�, Tests Required <br /> Phone Number <br /> cf'—' <br /> Samplers (Signature) Invoice <br /> Project Name `i _ AGE U <br /> Client ❑ <br /> Sample Location Sample Type No of /Q <br /> Number Description Date Time Comp Air Solid Cants � Notes <br /> Com <br /> 88806 <br /> IC <br /> � K , - <br /> r <br /> 21 _ ✓ x )< 88808 <br /> 88809_ r <br /> 88810 <br /> 13177Cr 1� , <br /> r <br /> X313--3 -Z�- �' `'`� �-� ✓ �� 1 8881 k <br /> .r <br /> 88812 <br /> I A— 1,>el 1. 1---LL L <br /> Relinquished y rgnatfure _ ecer y rgnature $ y.�J date/lime <br /> Gut �l't <br /> ' Relinquished by (Signature} !!!iowed by (Signatur ) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Dateffime <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Oate(rime <br /> Method of Shipment Labofator Name <br /> C'�Ic� c.�•�c�C e� P� ;' Z e L, <br /> Special Instructions I hereby authorize the peklormance of the above indicated work <br />