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i � ttttttt� � i• � �f, � fl• li � � � � � <br /> • i <br /> Advanced CHAIN OF CUSTODY RECORD <br /> - GeoEnviironmental, Inc. Date 1)o Page _-L ofA__ <br /> ,Jl <br /> 4005 North wison way-Stockton,Callfomla 95205.(209)467-1006-Fax(209)467-1118 <br /> Client Project Manager <br /> K A LA)n R'14 t 0G 1 vt- Tests Required <br /> Phone Number <br /> Xaq-- qt 7- 1,C'fD4 <br /> Samplers (Signature), h <br /> ,� Invoice <br /> Project Name V,t4lf f*1 � r sop e �fi.s�`,- r 1� ( '- y AGE <br /> [� t Client ❑ <br /> Sample Location Sample Type <br /> Date Time Water J_Air Solid Non Notes <br /> Number Description � <br /> Con np (crab <br /> '00 � �'�� •; I 32596 <br /> 5r'V It <br /> 32597 ` <br /> 32598 <br /> 5 wad o 5,a 3 }� - FT 32599 F <br /> k 1 32B00T <br /> 5W9 - 60 l�w��, � � � 32601 <br /> { <br /> -1+60 1 3202 <br /> �e{}nqu`s ad iy sgnature eca ved by gna ure s <br /> Dateffima <br /> Relinquished by (Signature) �.0 17-,00 <br /> Received by (Signature) <br /> DatelTima <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) <br /> [letaJTime <br /> I <br /> Dispatched by ISignaturel Date/Time Aecelved for aboratory by <br /> DatelTime <br /> Method of Shipmentame <br /> Laboratory N <br /> lit + Over VV� j -AMIninonmr-n H'-Ca rta b-kl,1 1 <br /> ICS ESERVA'>;ION <br /> Special instructions i hereby authorize the performance of the above indicated work <br /> )64'4^ VA,el4x_� <br />