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( Advanced, CHAIN OF. CUSTODY. RECORD <br /> GeoEnyironmen.tal, Inc. Date lZ `� Page Off <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006 Fax 209 467-1118 <br /> Client Project Manager Tests Required <br /> Phone Number <br /> Samplers: (Signature) lµ n �' Invoice: <br /> 4 / � <br /> Project Name ��trrf'1CG�1 ,�`i�c��t�Orrt, 't,r !�Lcira�f\ 1�� AGE <br /> Client r <br /> Sample Location Sample TypeNo. of <br /> Date <br /> Number Description Time Solid. <br /> Water { <br /> Comp. Grab. Air ' COnt$, i 83 <br /> ( t <br /> 14184 <br /> 016 <br /> i. <br /> i)Zr ✓ ✓ k 14188 <br /> . �'Z - �:�c' . � �/:- � ✓ �. � �G t�' ; ' 1418 9 -- <br /> e m uisa y: ( ign t ec y: rgn ture A.� �� <br /> /.- DatelTime <br /> G <br /> Relinquished by: (Signature) Rece ed by: (Si nature) Ff� 1 Q �ylfh AiV�JAS &G MLlrtl� <br /> Relinquished by: (Signature} ICnE/P n�1 P1 ESERVOON <br /> Received by Mobile Laboratory for field analysis:(Signature) GOOD CONDITION APPROPRIATE Date1 tme <br /> Dispatched by: (Signature) Date/Time Received for LaboratoryDatejrime <br /> Method of Shipment: , / Laboratory Name <br /> Special Instructions: /� lJ / L/� /1 / i hereby authorize the-.perfo mance of the above indicated work. <br />