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tint :fittitii�f w� v �■■■ r M M M MM <br /> CHAINF <br /> O CUSTODYCORD <br /> Advanced <br /> GeoEnviron mental, Inc Date ZZ Page -�L— of-,)- - <br /> 4005 North Wilson WayStockton California 95205 <br /> (209)467 1006 Fax(209)467-1118 <br /> Client V�y �� V t7I L. jr`t r e, Project Manager? I Tests Required <br /> PhoneNumber <br /> 2C CJ <br /> Samplers (Signature) �" Invoice <br /> Project Name T <br /> Client <br /> Sample Location Sample Type <br /> Date Ttme Water Solid No of Notes <br /> Number Description <br /> Comp Grab Air Conts t1,' <br /> eel�ingqu,s e y ( ig Lure) ecerve y (Signature) Dale/Time <br /> Relinquished by (Signature) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time RBceive for Laborat y Date[Trme o <br /> Method of Shipment [ , Laborator Name <br /> CA <br /> n (� J <br /> Special instructions I hereby authorize the performance of the above indicated work <br />