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i <br /> Advanced <br /> CHA! OF CUSTOPRECOR© <br /> � • <br /> GeoEnvironmental, Inc. Date � ll Page of_�_� <br /> 837 Shaw Road Stockton, California-95215 - (208) 467-1006 - Fax (203) 467-1118 <br /> Client U67CW10 Pro\N� Hagar t� <br /> � Tests Required <br /> P one Nu r <br /> - -- _. -- -- - -- - Sampfers (Signature) Invoice <br /> AGE <br /> Protect Name �r+ 1 Cis <br /> Sample Type <br /> Sample Location No of <br /> Number Description Date Tm�: ComWater I Air Solid Conts � v Notes <br /> p Grab y <br /> loo X X <br /> f <br /> Relinquished b igna e) �Rece;vedypnahircDate ime <br /> �c I6�O <br /> Relinquished by (Signature) Received by (Signcturc) Daielrime <br /> Relinquished by (Signature) Receij�d 3y Mabila Lrt;r atory for i :iJ A-oi;a^s (Signaturo) Date/Time <br /> Dispatched by (Signature) Dwo/Time lRocaived for Laboratory by %�'1 Date/Time <br /> 0)�' I (.S,L 9-1 <br /> Method of Shipment C�A1 Laboratory mace `( <br /> i Special Instructions E-67D nFfj ,, �/ (� � ��� 1 hereby authorize the performance of the above Indicated work <br /> IFV�` \ I A. v r <br />