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ass ets>•� w�� w■ �� !� 1>� �■■� t!w � � ti i! ti � i! i• � <br /> s s <br /> t Advanced CHATF USTODY R CORD <br /> GeoEnvironmental, Inc. Date Page of t <br /> 837 Shaw Road-Stockton,California-95215 -(209)467-1006- Fax (209)467-1118 + T <br /> Client s Pro�rt-Adar�age <br /> �Y`- Tests Required <br /> P ane N r <br /> �a 7 �0 <br /> Sample (Sig re) Invoice <br /> Protect Name 1 AGE <br /> tiM Client ❑ <br /> Sample Location Sample Type- <br /> No of <br /> Number Description <br /> Date Time Water Air Solid Conts Notes <br /> Comp Grab <br /> rdt L�)-Ltn <br /> "olZzI V <br /> e inquis y E nature L (Signature) at ime <br /> Relinquished by (Signature) VReceived by (Signature) <br /> baie[Titne <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) I Date/Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Datel[Time <br /> Method of Shipment Laborato e <br /> Special Instruction 1 herebyize <br /> au o t performance of the shave indicated work <br />