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{ Advanced CHATF USTODY CORD <br /> _-_- GeoEnvironmental, Inc. al� n�nn Date ` Page of <br /> 837 Shaw Road-Stockton. California- 85215- (208)4137-1006- Fax (208) 467-1118 <br /> Client f Pro eager Tests Required <br /> P no Nu ber / <br /> 6 7 <br /> a p (S azure} (� Invoice <br /> Project Name AGE <br /> Client ❑ <br /> Sam Type <br /> le T e <br /> Time p olid Sample Location Date TNo o4 <br /> COmp <br /> Number Description Water Air SConts � Notes <br /> (arab � <br /> �y 2-10 <br /> .s' « �s <br /> P FJ <br /> 3CE1 <br /> dip D SPACE A DST NC CONT tNI3R5 <br /> D rLORINATEb N LAB PRE5 RVE �Q & <br /> A9 O (r <br /> PR SERVATION <br /> e ina y ig atu --Receivedy gnature Ta0a ime <br /> 4A_ <br /> Relinquished by i Ignature) Received by (Signature) <br /> atelTima <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Daterrime <br /> Dispatched by (Signature) Date/Time Re boralory try Da 173e <br /> Method of Shipment Laboratory Fri <br /> r <br /> Special Instructions RECT SEALED& 1N ACT V'1A f hereby aut xe the pe 0 anon of the above indicated work <br />