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0 'S <br /> ( Advanced CHAlN F CUSTQDY ECORD <br /> , Inc.= GeoEnvironmentalinc `� <br /> Date Page of <br /> 837 Shaw Road-Stockton,California-95215-(209)467-1006 Fax(208)467-1116 <br /> Client 1 , <br /> Pro M ger <br /> Tests Required <br /> hone Nw r <br /> �i <br /> s ( ure)� � Invoice. <br /> Name <br /> AGE ❑ <br /> Sample Client ❑ <br /> p Location Sampl Type <br /> Number Description Date Time Water Air Solid No <br /> sf <br /> Comp Grab Notes <br /> IL <br /> •r <br /> t` <br /> �r <br /> } <br /> ns r <br /> Receive911SIgnahure) <br /> D te/Time <br /> :e7ftnuqhe y [ gnature Receive <br /> t7ate/Time <br /> Relinquished y ( }gnatura) Received by Mo fie Laboratory for Hal d analysis (Signature) <br /> t]ata/Time <br /> Dispatched by (Slgnature) Data rime <br /> ca va or aboretory by <br /> atalTl <br /> Method of Shipment <br /> i <br /> aboratory <br /> Spacial instructions <br /> I herby authorise the pe ormance of the above Indicated work <br /> -------------------- <br /> `� v <br />