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� � � I• fi � � � i• � t� �E tttr: tttttttttt■� ttttttttttt. �. � <br /> CHAIN OF CUSTODY R CORD <br /> Advanced Date �-�3 -�3 Page -L of 1 <br /> GeoEnvironmental, Ine ( � � <br /> 837 Shaw Road-Stockton, California-95215- (209)407-1006 Fay (?_09) 467-1118 <br /> Project Manager <br /> Client AC S �Irt L M���.1�,�r� zr Cr,L. MV61\69.r(' r Tests Required <br /> ad 1� `l ZWS ;-GMnt„ X) tLW Su , to , Phone Number 's <br /> AQ�,y% n T x 7 9 7A& Samplers (Signature) Invoice <br /> AGE ❑ <br /> Project Name Client J. <br /> �"lfl��-�'r� CC�C 00f'& i oY1 <br /> �. ,� C.? <br /> Sample Location Sam Ype <br /> Date Time Solid No of �� Notes <br /> Number Description cramp Grin Air Conts <br />�W's ��� zT 1 S-03 �~3 3o <br />\wi� 0(So_l <br /> 1w'1'�3 /0-L15o3 � ( <br /> I W II)o/t�LtN63 Dat"TtTwo <br /> in s e y ignature} see ye y r ure �,✓� <br /> n r ] DateJTime <br /> *CK.h, by (Slgnalure) (Signa ure ASN <br /> G D CONDPPIf7N PRLA1't� <br /> Date/Time <br /> Relinquished by (Signal�ture} � O <br /> for Signature) <br /> I <br /> Date/time Fie or aborator atelTime <br /> �/03 Dispatched by (Signature) <br /> Laboratory Name � <br /> Method of Shipment ��� �� <br /> l 0v fz�- rel 1ti <br /> I hereby n Drize the performance of the above indicated work <br /> Srecial instructions /J <br /> cof'r1P►- C�"!t/PGt' In 7A��C7'/ <br />