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fi fi fi ttttttttttl1111 CORD <br /> rstlttlttltt!# <br /> 3" <br /> Advanced CHAlN OF CUSTOD <br /> -_ � <br /> -� GeoEnvironmental, Inc. Date <br /> 3-1q-17 <br /> Page --L of " <br /> o/ Nonhcrri Califonua <br /> 1803 West March Lane Suite A-Stockton California 95207 (209)956-0264-Fax(209)956-e700 <br /> Client` Proieet Manager+ <br /> av- Pro �r- f Tests Required <br /> j Lr <br /> T Phone Number <br /> (2 01) 156-0Z 6 y <br /> Samplers (Signature) Invoice <br /> � <br /> Project Name AGS <br /> ! e <br /> Okll—f �q Client ❑ <br /> Sample Location Solid Sample Type No of Notes <br /> Number Description Date Time Water Air Conts <br /> Comp Grab <br /> Mil- 1 �� W-e,11 - 3-N-17 11, 00 X 3 VDA( y�7.0317-So - r <br /> U- 5 li it - 5 <br /> mw_� (I -- 6 <br /> VW- 1 <br /> e mquis edby ignature) Re etve y ignatur Date/Time <br /> ' S f 5 4CLr �, T -N--1 7 00 <br /> e mqutshed by Sinn to e) Recew (Sign tune) Date/To <br /> s �3-1,7 T 14" <br /> Retinqurshed by (Signature) Receive y bila Labor tory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Recewed for Laboratory by Date/Time <br /> Method of Shipment Laboratory Name Alo �i W <br /> Special Instructions I hereby authorize the p rformance of the above in rcated wo k <br />