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IN F CUSTODY%CORD <br /> � Advanced CHAIN , <br /> IZ <br /> GeoEn vironmental, Inc °ate t Page f of <br /> 837 Shaw Road- Stockton California- 95215- (209)467 1006 Fax (209) 467-1118 0 Z_%O 7/ <br /> Client -- Project Manager <br /> � l L�VQ <br /> � gists Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> Project Name _ AGiTE;'f <br /> ��� "6Client E]Sample Type � <br /> Sample Location Date Time Solid No of Notes <br /> Number Description Water Air Corns <br /> Comp Grab <br /> VU (n <br /> ekingws e y (Si nat r } Receivedy (Signature) DatelTime <br /> Relinquished by (Signature) Received by (Signature) DatelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date(Time <br /> n <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Date/Ti a <br /> Method of Shipment <br /> n _iZ�7 <br /> Special Instructions �� C` f I hereby authorize the performance of the above indicated work <br />