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M Mir M <br /> Advanced CHAIN OF USTODY RECORD <br /> , <br /> -- Date S 6Z Page � of <br /> GeoEnvironmental, Inc. <br /> 837 Shaw Road-Stockton, California- 95215- (209)467-1006- Fax (209)467-1118 <br /> Client 4 P ct ani r <br /> � �"� Tests Flegtatred <br /> P one Number <br /> alers (Signature) invoice <br /> Project Name UAGE <br /> k;e ,[ Client ❑ <br /> Sample Location Date Time Sample Type Solid No of s <br /> Number Description Water Comp Grab Air Conts Notes <br /> -3w <br /> mo <br /> 674.6-- -tom ) b --5�,✓ <br /> il 16/ ey L 1,o NA/ <br /> e in ui edKy g tura) Received by (Signature) <br /> te/Time <br /> - 04-L— <br /> Relinquished <br /> 1- o t)Relingwshe by (Signatur Received by (Signature) atelTime <br /> by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) DatelTimeRecew Ito ab rato Date/Time <br /> Method of Shipment Laborato ame <br /> 4 Special instructions 1 hereby a nze the performance of the above indicated work <br /> I - <br /> r _ <br />