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Advanced� <br /> CHAIr�N, OF CUSTODY RECORD✓ <br /> GeoEnvironmental, Inc. Date Page of <br /> 4005 North Wilson Way-Stockton,California-95205 (209)467-1006-Fax(209)467-1118 <br /> Client(, ga d�� � Project iManag Manager Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> Project Name11 99�� AGE <br /> L IYdI r[. 0 I Client ❑ <br /> Sample Location Sample Type Salid No of Notes <br /> Number Description Date Time Water Air Conts <br /> Comp Grab <br /> 33645 <br /> 33646 <br /> 15J 33647 <br /> 33648 <br /> 140 wqt! 13 33649 <br /> e inquis e y ( ign ure) Aeceive y (signature) <br /> T DatelTime <br /> Relinquished by (Signature) Received by (Signature) DaleffIme <br /> i <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysts (Signature) Date(Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Date/Time <br /> Method of Shipment Lab ry Name <br /> Special Instructions ,- " I hereby authorize he performance of the above indicated work <br /> WAS 0M 1 <br /> ICEJP..�. PRILSERVAT ON <br /> ELAD SPACE ABSENT CONTAINFkq <br /> It'i� Iter Ind sr� •c�,�` CA 0,A-_m-4kt__ <br /> �r <br />