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is • <br /> � Advanced CHAIN OF CUSTODY ECORD <br /> Date 172 Page -?— of <br /> --- GeoEnvironmental, Inc. <br /> 837 Shaw Road - Stockton, California-95215- (209)467-1006- Fax(209)467-1118 <br /> Client Top t n Project Manage A Tests Required <br /> Phone Number <br /> aoq —11(p7- �G <br /> Samplers (Signature) p� Invoice <br /> AGE 9 <br /> Protect Name Tai �� �' /th `� Client ❑ <br /> Sample LocationSample pe No of � <br /> Number Description Date Time Water Air Solid Coots 'L�' Notes <br /> Comp Grab <br /> w1V(./1z)1UJ -' � I -If-GI IGy3 <br /> JAI <br /> )(p b/ 17-110 -01 1017- l` � x <br /> Xj <br /> L)(�E/t2 lko r 10,L) <br /> L)76/ tL1101 r� [ V') 43`13 <br /> o7(- 42-110t f )w 3 X <br /> A�7b/ IZr1t? <br /> C"I 1z�°1 X 3 <br /> t`/ 1Zi101 1 <br /> e is e y ignature ecerve y i9 ture Dale/Ft e <br /> T �(r�C [� <br /> e wished by (Signature} Received by (Signature) atelTtm <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> I <br /> Dispatched by (Signature) Date/Time Rac for Laborato byil". Date(Time <br /> Method of Shipment Laboratory Name <br /> GAL ('ver n. ht 6,46 fle- I <br /> Special Instructions l hereb au ortxe the performance of the above indicated work <br /> 7 <br />