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• •Advanced CHAT O CUSTOD RECORD <br /> � � �3 <br /> _- GeoEnvironmental, Inc. Date Page --L Of <br /> 837 Shaw Road- Stockton, California-95215- (209)467-1006- Fax (209)467-1118 <br /> Client Pect Manager ��i C Tests Required <br /> V, l <br /> Pho a Number <br /> to v LQ <br /> Samplers (Signature) invoice <br /> Project Name Z ►VV 6!?A-V A-G,E- AGE <br /> Pgr <br /> Client ❑ <br /> Sample Location Sample Type Date Time No of J <br /> Number Description Comp GSand Notes <br /> rab Air Cords �� <br /> q15/03 1400 X, <br /> 5—2 4 ' 1 X x x <br /> NI- 101 o jo�5 i x x <br /> MIJ `210r D3 1 X X <br /> � of D-3 OSS 1 X X x <br /> X X X <br /> WN <br /> Z -- ! 03 1400 X i )(LX X <br /> inquis e ySi nature w <br /> a ee y (Signature) atalTime <br /> L 9 a3 I vd <br /> Relinquish d by (Signature) Received by (Signature) Date(Trme <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) �� Date/Time <br /> Dispatched by (Signature) Date[Time Received for Laboratory by Date/Time <br /> -1 0• go <br /> Method of Shipment Laborry Name <br /> 1�G., H-�— n/l"– 1--C(? 14- <br /> Special Instructions I hereby authorize the performance of the above indicated work <br />