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Advanced CHAT PF USTODY RECORD <br /> GeoEnvironmental Inc Date Page L Of <br /> 637 Shaw Road - Stockton California- 95215 - (209)467-1006- Fax (209)467-1118 <br /> Client ProjectM<a ger — <br /> � ( Tests Required <br /> P one NUMber <br /> s (SI ature Invoice <br /> Pro)ect Name 7-11�1 1 ACP „r' <br /> Client ❑ <br /> Sample Location Sample Type <br /> Number Description Date Time Water Air Solid Const Notes <br /> Comp Grab <br /> VAS 0& I IIdR t O'CHER <br /> low PREs RVATION <br /> GOODOO APPR)PRIATE <br /> DECffiARINATEI)IN IA I PH&II ERVED IN <br /> �Ielinquish d b ( na We ecelve y iQnature <br /> 0-;Err <br /> i eRelrnqu+she by ( gnature) Received by (Signature) me <br /> Relinquished by (Signatu(e) Received by Mobile Laboratory for field analysis (Signature) Daterrime <br /> Dispatched by (Signature) UaterrimeRece€ d for laboratory by <br /> tI <br /> t � 'yDa eJTime <br /> Method of Shipment } ` �J �I� � C L <br /> )i Laboratry ame <br /> Special Instructions VE hereb thorize t a p formance or above indicated work <br /> (�+ ;,I r-l•- ry 0A <br />