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Advanced CHAIN OF CUSTODY RECORD <br /> � � � �_ <br /> Dates 9 -�--- <br /> -- GeoEnvixonmental, Inc. �,,c � �' i?--'� Pae of <br /> 4005 North Wilson Way-Stockton,California-95205-(2&)467-1006-Fax(209)467-1118 <br /> Clientt Pro ect Manager Tests Required <br /> 'a r� S <br /> Lk <br /> t (t Z�� <br /> Phone Number <br /> &�qD —� <br /> Samplers (Signature) Invoice <br /> �j AGE,$ <br /> Protect Name CU CSS T[5���7 Gtr - Client E] <br /> Sample Type <br /> Sample Location Date Time Water Solid No of Notes <br /> Number Description comp arab Air Conts , - i <br /> �, � r 4 3171__ <br /> 1 1 � , <br /> 4 31 AL(*� <br /> 1 i� <br /> 4.q -n-ad h x � 43176 }� <br /> - <br /> � <br /> W-7/o-7--) �t 7 14' <br /> X k 43177 <br /> e inquis ed by (Signature) (Signature) <br /> ` c�J —'T7-/7--'J2>-Z <br /> Relinquis a by (Signature) i Rece�e Sr nature) Date/rime <br /> Relinquished by at ✓wr4�/ ... %V"X.A&lC Laj1ZLFJ.*q for field analysis (Signature) Date rime <br /> 7A <br /> Dispatched by ( g Date/Time Received for Laboratory by Date/Time <br /> Method of Shipment Laboratory Name <br /> ,(i7 ki ce- <br /> Special Instructions f I hereby authorize the performance of the above indicated work <br /> 7 VC <br /> r � <br /> Y <br /> y i <br /> J <br />