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Advanced CHAI F CUSTODRECORD <br /> GeoEnvironmental Inc. Date Page af� <br /> +/! 837 Shaw Road Stockton California 95215 - 209 467-1008 - Fax 209 487-1118 <br /> 0f- � ��b <br /> Client , Project Manager Tests Required <br /> MP6Vk�r,-GuX <br /> p <br /> Phone Nurpber <br /> piers (Si nature) Invoice <br /> AGE <br /> Project Name Client <br /> t <br /> Sample Location Date Time Sample Type Solid No of Notes Number Description Water <br /> �J Comp Grab Air Conts <br /> �kw� 0((Cl os. <br /> ei u y Received by tgnature DetefTime <br /> IPOW <br /> RelSqWished by {Signature Received by (Signature) DalelTrme <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Dale/Time <br /> Dispatched by (Signature) DatelTtme Received for Laborato by �Dale/Time <br /> C.n-(r <br /> Method of Shipment bo►atory Name <br /> --��-u-- <br /> Spectal Instructions l� f hereby authorrXe the performance of the above Indicated work <br /> I <br />