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� ��� tI� � � � � � � �� +, ■�� w� �� +�� ttttlw� ttiititititt� <br /> I Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date 6-$ Page 2` of Z <br /> (f Nanhcrn 0711f 1711(1 <br /> 1803 West March Lane Suite A Stockton California 95207-(209)956-0264 Fax(209)956-0700 �y <br /> Client Harirha+an in {s5 Project <br /> I<eU vl ticger K" both <br /> Tests Required <br /> Phone Number / <br /> (70q) 1756-0-264 <br /> ` Samplers (Signature) .� Invoice <br /> _ <br /> Project Name C biqs.t C � q vro 1 e P — Vol Bu r�e v� AGE <br /> ��� � Client <br /> Sample Location Date Time Sample <br /> Type Solid No of Notes <br /> a <br /> Number Description Air Conts - -- -� <br /> Comp Greb 1 j, t "h <br /> •174 S-6-74 19,00 <br /> 4,.nzA-A �h`1Es Hew <br /> MN1 `i7/ 5 `q4 10 70 <br /> Fr'R rr 'A. �``v'io7iR34 ter k�u; <br /> Re I inquis e y ( rgnature) eccrvB rgnature r /� yO Date/Time <br /> �&Ze" ir6 /16, <br /> Relinquished by (Signature) Re ved by (Signature)- Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> I <br /> Dispatched by (Signature) Date/Time Recorved for Laboratory by Date/Time <br /> Method of ShipmentLaboratory Name <br /> M ('- Cawf0k4j� - - <br /> Special Instructions I/hereby authorize the performance of the above indicated work 1 <br /> 1 M11 <br /> l'�Jl I <br /> (,rtr)gPArr AAgrNT J <br />