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0 <br /> AdvancedCHAIN QF YUSTODY RECORD <br /> -== GeoEnvironmental, Inc. Date �1101 1 IN Page � of � <br /> 4005 North Wilson Way Stockton,Califomla 95205 (209)467 1006 Fax(209)467-1118 <br /> ClientProject Manager <br /> `jb 1e ETr ��f L' �1 p Tests Required <br /> Phone NLpber <br /> Samplers (Signature) Invoice <br /> Project NameI �} � � 1 -�-�' ,cd AGE <br /> (Gt4 f 60,5 � 'G� �1 client ❑ <br /> Sample Location Sample Type No of <br /> Number Description Date Time Water Solid Cont a( Notes <br /> Comp arab Air s -� <br /> M���l�l��� 1� 1� [ �o (3 5 ✓ ti ti 56623 <br /> t} rCi 7 _—J <br /> IiL1o,tALL ,' ,l` st! 'I <br /> -141 iLIi <br /> �els e y gre} Received y gnaue i <br /> Date/Time <br /> / <br /> Relinquished by (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 R epedlc�r Laboratory by DatelTime <br /> e V tZ�12L (o J ?t,rn, <br /> Method of Shipment ( LaborattorAy Name <br /> 4 )�Jj <br /> Special Instructions I hereby author ze the performance of the above Indicated work <br />