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iftt;i � � � � � � � i• � � � � � � ri � <br /> Advanced CHAIN OF CUSTODY RECORD <br /> --- ,%' GeoEnvironmental, Inc, Q, Date Page eta <br /> 4005 North Wilson Way-Stockton,Califomla 95205-(209)467-1006 Fax(209)467-1118 <br /> Client Project Ma ar <br /> C�L ~ Tests Required <br /> P e Nmbar <br /> (-,?D9 )6��2- I <br /> Sa S (Sig ure) Invoice <br /> Project NameAGE <br /> Z6 ela Lit I, V_12 Client ❑ <br /> Sample Type <br /> Sample Location No of <br /> Number Description Date Time Water Air Solid Conts Notes <br /> Comp Grab E i <br /> 49836 <br /> IU l V iL - F"k4 IN - <br /> e iDpishadp (Sign lure) fleceNe y ignature D lelTime <br /> 0 Z73 <br /> 6 <br /> Rehnquiehed by (Signature) Received by (Signature) Daternme <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Timer <br /> ate rimeei ed kn-Laboratory by DatetTime <br /> WWZ t01ir C"- IAP1 <br />� Method of Shipment Laboratory tJ me <br /> 1 <br /> Special,instructions I her y au orae the erf rmance of the above Indicated work <br />