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! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! <br /> Advanced CHAIN OF CUSTODY ECORD <br /> Date .��-���s� Page —L— of—�— <br /> GeoEnvironmental, Inc. _L4�,e LA <br /> 4005 North Wilson Way-Stockton,California 95205-(209)467-1006-Fax(209)467-1118 <br /> Client I r �C Project Manager Tests Required <br /> P one Number <br /> Samplers (Signature) T invoice <br /> Project Name ; � � �3� AGE,& <br /> Client ❑ <br /> � <br /> Sample Location Date Time Water Sample Type Solid No of Notes <br /> Number Description Air Conts <br /> Comp I Grab <br /> 50886 <br /> Kry))�')C'nre L4 t/A 17371D X y <br /> 50887 <br /> gn <br /> -�r ►� �� rJVI ok x 50 888 <br /> h <br /> -ff x.13 `-¢ k k 50889 <br /> l <br /> % k 50896 <br /> ,w��lt -12 x '` 5089 i <br /> x 50892 <br /> Re u (S nature) ecerve y 1gnature <br /> � r <br /> rs (Signature) Received by (Signature) Date(Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Received for Laborat by l� Date/Time <br /> Method of Shipment Laboratory Name <br /> Special Instructions 1 hereby auth rize the pe ormance of the above indicated work <br /> l <br /> f <br />