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Advanced CH O CUSTOD4ECORD <br /> ( c� <br /> --_^ GeoEnyiron mental, Inc. Date Page <br /> 837 Shaw Road - Stockton, Californla- 95215 - (209) 467-1006 - Fax (208)467 ill <br /> Client 7 Pro Man er <br /> Tests Required AM <br /> one Number <br /> Sam ers (Signature) invoice <br /> Protect Name ` v / � f3l <br /> AGE <br /> y�y� Client ❑ <br /> SampleData Time Water Type Solid J <br /> Sample Location — No of <br /> Number Description Comp Grab Air Conts r` Notes <br /> r < <br /> -' <br /> —RelinquisVeed <br /> y i natur eceive y gesture tefrime <br /> 6,7 — <br /> R <br /> � <br /> Relmquis by (Signature) Received by (Signature) Date/Tima <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Slgnature) Date/Time <br /> r <br /> Dispatched b (Sc nature Date(Time ecelvel!I r aboratory {late(Time <br /> p y-(Signature) <br /> Method of Shipment Laboratory a e , <br /> Special Instructions 101 hereby u Fixe t ert rmance of the above i+dicated work <br />