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0 <br /> Advanced CHAIN OF CUSTODYIECORD <br /> 4 C;01 <br /> � � <br /> � � 4 Date >!� y Page of <br /> GeoEnvironmental, Inc E �� <br /> 4005 North Wilson Way-Stockton,Caltfonva 85205-(209)467-1006-Fax(209)467-1118 <br /> I Pro ect Mana er <br /> Client � � 61 E� lL t sotj Tests Required <br /> Phone N <br /> uber <br /> 7` 0- 16,06- h 63367 s <br /> 5 <br /> piers (5 nit re) 4 63368 <br /> Project Name �+iP�Sfc. ' �! BItW ` 1---61169- <br /> Sample <br /> X1169Sample Location No of Sample Type SolSolid63370 <br /> Number Description Date TimecomWat Grrab Air coats <br /> � fi3371 <br /> a 4< �' �c�•�1 � �� <br /> AW21- ZZ, <br /> '6,1 1�act <br /> I <br /> alct. 3n. 5rZ l �f k ! IH <br /> 63373 <br /> qui ed Zy { ignature) ecewe y (Signature) Date/Tt e <br /> 0j'! o <br /> Rillinquished by (Sinature) Received p i,�gig OTHER <br /> YVi1J VOt rSi.A V G7S <br /> Relinquished by (Signal yf OD CONDITION of <br /> field analysis (Signature) Date/Time <br /> Dispatched by (Srgnatu{j �.�� _ Dale/Time FRecepyed for Laboratory by Dateffime <br /> .� <br /> Method of Shipment Laboralofty Name <br /> 00J�- f�l <br /> Special Instructions I hereb authonze`he pert rmance of the above indicated work <br />