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�Adi alced CHAIN OF CUSTOD CORD <br /> _ G o nvironmental, Inc. Date_ ��.�r`gS Page �- of 2 <br /> j Northern Califonua <br /> 1803 West March Lane,Suite A-Stockton,California-95207 (209)956-0264-Fax(209)956-0700 a <br /> ClientProject Manager <br /> q>*?+'>'1 Q h h '�" 2�'h �S S Tests Required <br /> Phone Number <br /> (20q) 75-6-024LJ <br /> Samplers (Signature) -C, Invoice <br /> ProlectName GaSf ' V , AGE <br /> a Client ❑ <br /> Sample Location Sample Type <br /> Number Description Date Time Water Air Solid No Con of '� Notes <br /> Comp Grab , <br /> MW 17 1- l <br /> s s�3 Manioc ��-r7-4S 10.3 . X � x 'I � 58884 � <br /> i <br /> �e/inqurs e y ( ignature) ece i nat <br /> Y 9 Ir o?o��g� 5�ariddN �' T_ UatetTrrne <br /> Relinquished by (Signature) served by (Sign ure) <br /> Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysts (Signature) , <br /> Qate(rime <br /> Dispatched by (Signature) Date/T$me Reserved for Laboratory by Date/Time <br /> Method of Shmens <br /> �i v��nr Laboratory Name <br /> � Ojn �` e � <br /> Special Instructions KC-Cam0#11 <br /> I hereby authorize the performance of the above indicated work <br />