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Advanced CHAI 04 CtJSTODY RECD <br /> =- GeoEnvironmental Inc. Date Page of <br /> 837 Shaw Road- Stockton, California- 95215 - (209)467 1006- Fax(209) 467-1118 <br /> Client Pr ptya ger <br /> Etc 6"_x:w_— &g �& <br /> Tests Required <br /> Phone N11mber, <br /> Sa Tmrk (S nature) Invoice <br /> Project Name ` LI-t� AGE,®— <br /> ClientI z <br /> ❑ <br /> Sample Location Sample Type No of <br /> Number Description Date Time Water Air Solid Cants Notes <br /> Comp Grab <br /> 1 1 r 136 <br /> e inq Reciolvea 6y '(Signature) t7 e1T me <br /> ZL <br /> Relinquished by (Signature) U deceived by (Signature) eIf,me <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date[Trme <br /> Dispatched by (Signature) Dateffirne Received for Laboratory by DatelTrme <br /> Al V- 22r;1,-( fEad� <br /> Method of Shipment Labor or m <br /> Spacial Instructions I hereby a rize th erformance of the above -ndicaled work 1 <br />