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� � � � w � � � _ ._ _ _�.. _ , <br /> Advanced CHAIN OF CUSTOC - RECOhD <br /> GeoEnvironmental, Inc. Date lk69 Page --2--at : <br /> 837 Shaw Road- Stockton, California- 95215 - (209) 487-1006- Fax (209)467-1118 <br /> Client �G�-' c � P70cl Manager <br /> ne. ~ t f �✓ Tests Required <br /> Phone Number <br /> 4-2 /d6�, <br /> Sam Pers (Signature) � h � Invoice <br /> Project Name �. ,� �( AGE <br /> p� Client ❑ <br /> Sample Type V <br /> Sample Location Date TimeWater Solid No of LN Notes <br /> Number Description comp arab Air Conts <br /> W�h2 x r.&rq ye <br /> Raj' uis Ig Receivedy gnaura Dole/Time <br /> h (Signatufe)ed by <br /> Received by IStgnatura) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) DatelTime Re r Laboratory b <br /> sc— <br /> Method of Shipment Lab af0Z- <br /> ryJJ <br /> Special Instructions / h � � �� _- I hereby au4harize a performance of the above indicated work <br /> 1 <br />