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I• � � � I• � � � � � � � t� e• t,� ttii� +_ <br /> ( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Z5�.� bate d� Page of <br /> 4005 North Wilson Way Stocklon California 95205 (209)467-1006-Fax(209)467 1118 <br /> Client Protect Manager <br /> _ Tests Required <br /> Phone Number a <br /> 265- - � <br /> Samplers (Si nature) / Invoice <br /> AGE <br /> Protect Name G / _ / try v Client <br /> 1"Alf- A/ — rs u /1 1 <br /> � •i1 , yi <br /> Sample Location Sa YPe Na of 1�/7 �C <br /> Number Description Date Time Water Air Solid Conts Notes <br /> Comp Grab <br /> rv/ .3 nil A-' 64472 <br /> i, <br /> 64473 , <br /> 64474 <br /> d _ , L <br /> {� y <br /> 6330a, x 64475 <br /> e),3306I i <br /> �•�;LV 033a61 00 �( 64476 <br /> � tU� 033rJ"Ji �( - <br /> � � y7U c, 64477 <br /> 64478 <br /> -r4a 3 L <br /> eWi.h,,tby <br /> y ignatur Received y (Signature) uardr I rola <br /> 4ys)zvt /Ci830 <br /> Rei (Signature) Received by (Signature} Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) f]alelTrme <br /> Dispatched by (Signature) Date/Time ffece v for iJ abotatp y — D telTime <br /> Nle Q / ll- Da <br /> Method of Shipment La ratory Name 7 <br /> elLc— <br /> Special instructions i hereby authorize the performance of the above Indicated work <br />