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( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc 03b S Date S 7_o Page �_ of 2- <br /> 837 <br /> 837 Straw Road - Stockton California- 95215 (209)467-1006 - Fax (209)467 1118 <br /> Client L S 4KO Protect Manager Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> Protect Name -- a , - AGE <br /> C hese- V(Lr1 �� ��i1 ,�f�' ✓ p Client ❑ <br /> >ti <br /> Sample Location Sampl ype No of Q <br /> Number Description Date Time Water Air Solid Conts �� Notes <br /> Comp Grab <br /> MW-3/0YO-70I &1t_' X <br /> MW 6 1050 7o <br /> I11W7 �SO�v-; fel <br /> MWq oz 7V3 <br /> L___ - 17 A <br /> fmj��/ <br /> Aw4r/a 703 <br /> e y ignature) ece ve y rgnalure <br /> Oat (Time <br /> finqurshed by (Signature) Received by (Signature) DatelTime <br /> Rehngatstigtl bar (Signature) PUTMAI?AI?4 ;' f eceive b F>lobi Laboral ry for field analysis (Signature) Date/Time <br /> sS <br /> ii f1 <br /> Dispatched by (`,rgnature) yAi;ti �,to f, J t�vY Date/Time Received for Laboratory b Date/Time <br /> Method of Shipment Labora ory Name fJ <br /> Special instructions I hereby authorize the perforfinance of the above indicated work <br /> A . Y Or I l r n <br />