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MOM M �>• �■ liiiiiiiiiiiiiii4r <br /> CHAIN PIF CUSTODY RECORD <br /> AdvancedDate (5 t z(04 Page --L-of__�__ <br /> GeoEnvironmental, Inc <br /> 837 Shaw Road - Stockton, California- 95215- (209)467-1006- Fax (208)467-1118 <br /> (96 - <) 9 <br /> Client Pr ger Tests Required <br /> �� r <br /> Niunber <br /> 1 (, b 7 - W6 <br /> Samplers (Signature) Invoice AGE. <br /> AGE <br /> Project Name1 ClientF- (] <br /> Sample Type No of <br /> Sample Location Date Time Water Air Solid Conts Notes <br /> Number Description Comp Grab <br /> f <br /> r <br /> r na ura De W <br /> e <br /> ee ill a lignature) ell Y 9 l Z <br /> Date/Trm <br /> Reimqui ed by nate Received by (Signature) <br /> /� Datefrrme <br /> Relinquished by (Signature) Received by Mobile Laboratory for held analysis (Signature) '15 <br /> Date/Time Received for Laboratory Drip <br /> � Dispatched by (Signature} <br /> L oratory Kama <br /> Method of Shipment L <br /> c <br /> Jillr i' <br /> I hereby authorize the performance of the above dicated work <br /> Special lnstruchln <br /> r <br />