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�� � �� � tw�fr iffffffffA f� 1� f♦ � � j_ - <br /> ( Advanced 01 <br /> CHAI OF CUSTODECORD <br /> GeoEnvironmental, Inc Date �� Pageof <br /> - 2 <br /> 837 Shaw Road - Stockton, California- 95215 - (209)467-1006 - Fax (249) 467-1118 <br /> Client E r 4u__ TProect Mana er <br /> / Ltd& <br /> Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> _ AGE V <br /> ma <br /> Project Name LIM) TUU—I o"s ( Client ElSample Location Sample Type of <br /> Date Time Water Solid Notes <br /> r <br /> Number Description Comp Cr Air Conts <br /> e ingp edby ( L*7- <br /> Receivey ignature Date/Trme <br /> Relinquished by (Signature) Received by (Signature) ' • ` Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Daterrime Received for Laboratory by �� Date/time <br /> Method of Shipm.ppt �/,� Le ora ry Name <br /> Special Instructions f hereby authonze the performance of the above Indicated work <br />