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Advanced CHAIN OF CUSTODY RECORD <br /> � _ � C z <br /> GeoEnvironmental, Inc. Date page or <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-111 ` <br /> Client <br /> Project Manager Tests Required <br /> KI V,vl 11 l5 'hrti1 <br /> Phone Number <br /> ,-c cl - It 6­7 -100 6 <br /> Samplers: (Signature) Invoice: <br /> u r y r �i t'U v�. '�",iL c l y �� y t c AGE <br /> Project Name tall C ( � / u rc , ,v ` }° Client ❑ <br /> C;Md1�t <br /> Sample Type <br /> Sample Location Date Time Water Solid No. of �`� ��.�� ,� Notes <br /> Number Description Comp. Grab. Air Cants. . <br /> SP 50(0 � - <br /> A A A <br /> T � 1 A w,sl i44 , IOU) 16752 <br /> AA <br /> 16753 <br /> .r K A- M4,11- L i 50, l 1' -vff 16754 <br /> T l5 113 Vor1 k 'ttc i 09 X X 16755 <br /> I u5T )7 1 �( X X : .16756 <br /> c,i< 3t3 NoT?>1 ,uC-1 x X 16757 <br /> He inqurs a y: (Signature) flec rve y: i na ure {; Cy N r- T• ,� <br /> 4/1it,c ! <br /> Relinquished by: (Signature) Received by: (Signature) {�'SH f �/ T{;30t'n FM7C(R�/ Dale(Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) / / DalelTime <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: DatelTime <br /> Method of Shipment: Laboratory Name <br /> L� C1Vrrytiyk7 M c. (Cral) h I <br /> Special Instructions: �_y / n O&� M�A�r+ kyr h I hereby authorize the performance of the above Indicated work. <br /> V/ rRESERUATION M J GJI ff <br /> HEAO SPAT T---- Arrilut111ATE <br /> CLI ai- e(ti+v' <br /> C4Vciv`e.1 W1(-1 <br />