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�• ttttttwnr 4r � t � IIIIIIIN11 = =1M <br /> ( Advanced CHAT 0 FA <br /> CUSTOD ECORD <br /> GeoEnvironmental Inc, Date Page --�-- o1Z <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1116 n�� <br /> !31z Ig G& 1 <br /> Client - ProjectHager <br /> Tests Required <br /> P eumber <br /> )1)/,:7 <br /> Sa s { natur ) Invoice <br /> Project Name AGE,e' <br /> M.tr Client ❑ <br /> � <br /> Sample Location Date Time Sample Type No of <br /> Number Description Water Air Solid Cants Notes <br /> Comp (arab t <br /> 30147 <br /> 30148 <br /> - <br /> v) 3 30149 <br /> A-IMU) J/ X 30150 <br /> 30151 <br /> 30152 <br /> U-2Z Y, L�/ >I1 <br /> el t r e y (Vignr eceivey ignature Date/Time <br /> yp f c�7 ktt1�Rehm uished y ( re) Received by (Signature) Date/Time <br /> Relinquished by (Signalure) Received by Mobile Laboratory for field analysis (Signature) DatelTime <br /> Dispatched by (Signature) Date/Time Received for Laboratory by DatelTime <br /> Method of Shipment �pI& � Laboratory Name <br /> A ly �4L� G• <br /> Special Instructions IcE� �� 0&G METALS OTHER I hereby authorize the srforma oe o1 the above indicated work <br /> IlPRESERVATI <br /> APPROPRIATEHEADS ENT rInkrullil9pq <br /> L �J�� <br /> CC 06 r� ep-,Lr{{ Se0(r �} 1Y <br />