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Advanced CH O <br /> F CUSTODYECORD <br /> � AIN <br /> eoEn�ironmental, Inc. Date OVt j Page of <br /> G <br /> 4005 North Wilson Way Stockton,California-95205-(209)467 1006-Fax(209)467-1118 <br /> Client CAC Fue f S Project Manager Tests Required <br /> Tr M cve/le'r <br /> Phone Number 4, <br /> ,101 - `167- /OCA <br /> Samplers (Signature) r� Invoice, <br /> AGE <br /> Project Name CA/ Fi. Z) S Client0 <br /> L e � <br /> Sample Type <br /> Sample Location Date Time Water Solid No of �� r Notes <br /> Number Description ComAir Conts <br /> p Grab <br /> �W2A L ,alo1 i!� 1030 X <br /> eh�rp iy s e y (Sign lure — Received y (Signature) Date/Time <br /> Relinquished by (Signature) Received by (Signature) Date rime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Dale(Tims <br /> Dispatched by (Signature) Date[Time Receiv for boratory //D��alIteP {ryfj <br /> �vV A I <br /> -'� <br /> Method of Shipment Laboratory dame <br /> CAL Qogr <br /> Special Instructions I hereby authorize the performance of the above indicated work <br />