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4r <br /> ( Advanced CHAIN OF CUSTODY RECORD S <br /> GeoEnvironmental, Inc Date za0 0 Page —J— of j <br /> 4005 North Wilson Way-Stockton Caldomia-95205 (209)467-1006 Fax(209)467-1118 <br /> Client RAI n W O4C W Project Manager <br /> I Tests Required <br /> I Phone Number <br /> -- Samplers (Signature) k, ab Invoice <br /> Project Name �� i , + `I+ �` AGE—�� <br /> Client ❑ <br /> Sample Location Sample Type , <br /> Number Description Date Time Water Air Solid C. (k N Notes <br /> k Camp Grab <br /> — y4Tp'I r wofr� <br /> S&144 t y5 y +�vcRS <br /> I-� 342 - lw <br /> PCA�LY11f'�1� r�W <br /> ! ! <br /> r <br /> ul I <br /> �� �°f y �• ` •� C'13$?a 1 Pr �O� r A <br /> I <br /> ( Hot.inqus e y (Signature) Received by Ignature <br /> STI)0o R �a►err,me <br /> Rehnquiahed by (Signature) Received by (Signature) zol o ate/Time <br /> l <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) lfe�aa� C 1�,�`.I'_- Date/Time <br /> teel—r`ld lo 5�7� VvAtcrr <br /> 12 <br /> Dispatched by (Signature) Date/Time Received for Laboratory by l <br /> IJQ <br /> _ Date/Time <br /> 1 ®LI U ( 55 <br /> Method of Shipment Laboratory Name <br /> C-AST)'E AN ` A�L <br /> Special Instructions I hereby authorize the performance of the above Indicated work <br />