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ftftl• i_ ffr• i• ftp i• fi♦ l• i• i• f• 1• t• f� t• i• f� \i• fi♦ <br /> • . s <br /> Advanced CHAIN OF CUSTODY Rb4 <br /> GeoEnvironmental, Inc. Date Page ot <br /> 837 Shaw Road-Stockton,California-95215-(209)467-1006- Fax(209)467-111a <br /> Client ProjecWanager Tests Required <br /> Phone Number <br /> 6- <br /> Samplers (Signature) Invoice- <br /> Project Name17 AGI= K.SSClient I-]44 C' <br /> & — <br /> Sample Location Sample Type No at <br /> Number Description Date Time Water Air Solid Conts Notes <br /> Comp Grab � <br /> re/n ' � 7z,� x x 73780 <br /> ' rc�S" 7rt7 /�' 73781 <br /> Vii uJ6 al,&701 -k 73782 ; <br /> W-)/M o 61 71Z71VI /7 f/10 73783 <br /> t , <br /> 6000 0ND1T10N P 0PPIAT li;� W� _ <br /> e t e y �gnatu , cave ey g Date/Tim <br /> t <br /> Ra gwshed by (5i azure) Received by (Signature) Date ime <br /> Relinquished by (Signature) Received by Mobile Laboratory for held analysis (Signature) Date/Time <br /> Dispatched by (Stgnatufe) Date/Time Race ved for Laboratory by Date/Time <br /> Method ofnZ <br /> Laboratory Name <br /> C <br /> Special Instructions I hereby authorize the perf rmance of the above indicated work <br /> r <br /> 4 <br />