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■sew a: o� rttttittttt� ittit>i tttttttttt>• titilililtl• ttf� I• IM 1• <br /> Advanced CHAIN OF CUSTODY CORD <br /> GeoEnvtrminiew-al, Inc. Date Page <br /> IR/ - <br /> 837 Shaw Road- Stork+ n, c ahfornia-95215- (209)467 1006- Fax (209)467-1118 � � f-� LJDe5 ��r <br /> r <br /> Client r, c C Project Manager Tests Required <br /> J <br /> ` S � � <br /> �� CkRt'rt- Phone Number 4 <br /> Sampl rs Signature) Invoice <br /> Project Name L�j �� AGE ❑ <br /> R ,,Q <br /> r� �, s�� � � �,.� 1{/ � �',�'' _"� ,+ !� Client � <br /> Sample Location <br /> Number Description Date Time gar Water Ype Solid No of �� ''�� Notes <br /> Comp Grab Ali ContS <br /> PT-2- 10 0817 �. <br /> OV <br /> 09N, <br /> e in i y { gatur eive yr7a�--- <br /> r Date/Time <br /> f l 12-7 <br /> quished by (Signature) Received by (Signature) DatelTrme, <br /> Rehnquwshed by (Signature) Received by Mobile Laboratory for field analysis (Signature) Datef ime <br /> Dispatched by (Signature) DateJTime Received for Laboratory by Date/Time <br /> Method of Shipment Laboratory Name <br /> (2c.iie� � _,# t AS0r� � <br /> Special instructions I hereby autho ize She performance of the above indicated work <br />