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.1111111 11�111 l• <br /> i <br /> � Advanced is <br /> CHAT F CUSTODY"RECORD <br /> GeoEnvironmental, Inc. Dat Page of <br /> 837 Shaw Road - Stockton, California- 95215 - (209)467-1006- Fax (209) 467-1118 O <br /> Client Project Mana r { <br /> j J f Tests Required <br /> c� <br /> Phone Number <br /> AB WIZI <br /> Samplers (Signature) / Invoice <br /> Project Name C <br /> AGE <br /> J 0' j Client <br /> Sample Type <br /> Sample Location Date Time Water Solid No of Notes <br /> Number Description comp Grab Air Conts <br /> pis <br /> eli lHeceivedy ignature Dat rme V C TA-7— tDa <br /> Relinquished by (Signature) Received by (Signature) C/1+ ��i Date/Time <br /> Relinquished by (signature) Received by Mobile Laboratory for field analysts (Signature) Date/Time <br /> Dispatched by (Signature) DatelTrme Recewed for Laboratory DatelTt e <br /> ~ / " dpr <br /> Method of Shipment L rato�y Namee / <br /> T A <br /> Special instructions f hefeby authorize the performance of the above indicated work <br /> AA <br /> w -v a,LA::. <br />