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ww■: w■� w w �� <br /> Advanced <br /> CHAT F CUSTODRECORD <br /> Page of� <br /> � � <br /> „'� GeoEn�ironmental, Inc. Date g� �-- <br /> 837 Shaw Road-Stockton, California-95215-(209) 467-1006 Fax (209)467-1118 <br /> Client Project Manager <br /> Tests Required <br /> Ph a Number <br /> Sam ers Ignaiure) Invoice <br /> Project Name AGE <br /> Client ❑ <br /> Sample Location Sample Typepate Time No of <br /> Number Description Water Air Solid Cants Notes <br /> Comp Grab <br /> !�J a2 - ~ <br /> 6 I - <br /> �v '133 Ail >m <br /> `v k <br /> 1�t�c.t l�2�?_o )1,r k <br /> 7371 1 <br /> e ine { i nature Receivedy (signature <br /> atelrime <br /> E70 <br /> 6& <br /> Relinquished by (signal Received by (Signature) DatelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) � Datef ime <br /> Dispatched by (Signature) Date/Time Racal d r Laboratory y Date/Time <br /> o y2 6 a <br /> Method of Shipment Laboratory me IT <br /> ( e <br /> special Instructions 1 hereby authorize 0 performance of the above Indicated work <br />