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Advanced CHA N F USTODY RECORD <br /> - -= GeoEnvironmental, Inc. Dates Page l of <br /> 837 Shaw Road Stockton, California-95215 - (209) 467-1006- Fax(209)467-1118 O — 110 <br /> Client f i'rolfI Manager Tests Required <br /> )Ct At CA <br /> Pho/n,%Number <br /> Samplers (Signature) Invoice <br /> 10 .71 <br /> AG E <br /> Project Name '/ �" l � le-1,2e0� ,� - Client C] <br /> Sample Type <br /> Sample Location Solid No of Notes <br /> Number Description Date Time Water Air Conts <br /> Comp Grab <br /> Hw <br /> Re' quished gnature) eceiva y ignature � atelTime <br /> 9 ,5 16eo <br /> Relinquished by (Signature) Received by (Signature) DatelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/time Received for Laboratory byYJt?ate[TiAA,—Jhe, me <br /> Method of Shipment Lab ry <br /> I hereb authorize the performance of the above indicated work <br /> Special instructions U <br /> Ae� <br />