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j� 1♦ � � � � � � � � iiiiiff� its fffitififififs �� tttitiiitittttr � � <br /> Advanced CHAIN OF CUSTODY RECORD <br /> � e <br /> GeoEnvlronmental, Inc. Date y` Page —L of� <br /> of Northern Caltfonna <br /> 1803 West March Lane,Suite A Stockton,California-95207-(209)956.0264-Fax(209)956-0700 <br /> Client —Fop F-tL <br /> lient - 1 T,Project Manager Tests Required <br /> j� Guel� <br /> Phone Number Qq_c15(—026 LI <br /> Samplers (Signature) Invoice <br /> AGE <br /> Project Name To , Ff f i I �'� gt <br /> I f %> �,� Client ❑ <br /> � h <br /> Sample Location Sample Type <br /> Date Time Water Solid No of Notes <br /> Number Description Air Conts <br /> �-r Comp Grab <br /> MW - 2 t - 2 Z ' <br /> II Vu — 3 +t fr — <br /> I l w — LJ ( '' — L( <br /> e iPquis e y (Signature) ece—iv ed y ignature Date/Time <br /> Relinquished y ( nature)- Received by (Signature) DatelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatetTime <br /> i <br /> Dispatched by (Signature) Date/Time Rec Laboratory Date/Time <br /> Y (S 4 <br /> Method of Shipment Laboratory Name <br /> C-4767 a I L <br /> Special Instructions I hereby authorize the performan a of the above indicated work , <br />