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i <br /> Advanced CHAIN OF CUSTODY RECORD <br /> =?- 2f Date 02- 1l 1 Page of <br /> GeoEnvironmental, Inc. <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1 118 <br /> Client Project Manager <br /> Tests Required <br /> Phone.Number ./ <br /> Samplers: (Signature) Invoice: <br /> Project Name �LL=d���v` lr ry AGE <br /> l ti TL� I ? �L �o?may Client p <br /> 1 0 <br /> ` � 1ovr ,WQ ��ti �' v <br /> Sample Location Sample Type No. of <br /> Date Time Water Solid Q <br /> Number Description comp. stab. Air Conts. +� <br /> Z 0tlJq 610:53/401l f _ 4 ,5AivlaLt:- S' F-bC <br /> C�Z 11 q`f 9.0"JAwt <br />>S 2- <br /> - 4 <br /> eRe in uis e y;Fs nature} Received y: ignature Date/Time <br /> 1, 7a ��zr�-`��-� 2A TA- ¢ 11 ,1r -P as pm <br /> Refinr} hid by; (Signature} Received by: (Signature) 'Date/Time <br /> r c <br /> Relinquished by: (Signature) _!j E7�y q�(v �yi6dgbr a C' bof t lysis: (Signature) Date/Time <br /> r� �fT� t Ita.l i l v i !�J-IV <br /> Dis atched b (Signature) l rtf}irl c nt4t `���^' ril `r i e/T' Received tot Laboratory by: Date/Time <br /> p y: g ) I-11-AD SPACE ABSCNT CONTAINERS <br /> ,Z <br /> Method of Shipment: C�(�)I e Laboratory Name <br /> Special Instructions: I hereby authorize the pet.lormance of the above indicated work. <br />