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j Advanced CHAIN OF CUSTODY RECORD <br /> Date U? Z `i Page of� <br /> ;- GeoEnvironmental, Inc. <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 114680 XSa G,�3 <br /> Client Project Manager <br /> �I /� �, S i� �1 et,� r4T IvW g 1~ Tests Required <br /> PhoMI) <br /> Number <br /> 4-o -1 oO6 ti Nti <br /> Samplers: Signature) ��'� Invoice: <br /> AG E ,< <br /> Project Name (, n Gr1i'" �lti�.f��iG'Y ''�� �� ,r r��` Client ❑ <br /> Sample Location Sample Type No. of <br /> Date Time Water Solid <br /> Number Description Comp. crab. Air Conts. <br /> T5 /4 50iA+�, +✓ASS ,rr Z Z'z i-I VLOFm <br /> �Y . <br /> T S L 'I 111 Ndr+tl CAST <br /> T 5 <br /> e r us a y: (S, ature}r acc v y: (Signature r g „F Date/Time <br /> rLtCl��-`� cure. �- 3 �d$3l3 �i/ J{7Hr'17 7 I�►'T- • :0 <br /> Rolin ,shed by: (Signature) R ,vad by: (Signs re} DatelTime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis; (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Date/Time <br /> Method of Shipment: ?E i J Laboratory Name <br /> GC J � � � !� -�1 E�f�.� <br /> Special instructions: C 0 ( QN �• I I_hereby authorize the perfor ante of IV &� � 01 <br /> V PRESERVATION V 4[ ttf{ tJ <br /> i�ir"' A►u xt� 3 e rivAj '`" G 01)CONDITION.. APPROPRIATE <br /> b:SE`ABSE�1 <br />