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( <br /> CHAIN F USTOD ECORD <br /> Advanced <br /> GeoEnvironmental, Inc. Datepage -- of�— <br /> 837 Shaw Road - Stockton, California- 95215 - (209)467-1006 - Fax (249) 467-1118 <br /> Client t S Prole"onager <br /> Tests Required <br /> P e Nuknber <br /> — <br /> Sa to (Signature) Invoice <br /> Project Name1�71AGE <br /> �. Client ❑ <br /> Sample Location Sample Type Q' <br /> No f <br /> Number Description <br /> Dae Tirrttr Water Air Solid Cants Notes <br /> Comp Grab <br /> i <br /> 12-34D <br /> t / >'3iEMVA N <br /> aAPPROPHTA <br /> C— SPAC1 ABSENTi/ CONTAINEW <br /> DEIRWRINAT&D IN LA$-PRL9EWM IN <br /> am uis y 1 atur eceive y ignature Da (Time <br /> zv <br /> Rdlinquished by (Signatur ) Received by (Signature) <br /> ate/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date(Time Received for Laboratory b at IT�me <br /> Method of Shipment Laboratory a e C <br /> ,JeW <br /> Special 4nstructkons I hereby auth a the perfor ante of the above indicated work <br /> ro\4- k 1��4 VI 7 <br />