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f <br /> CHAT OF CUSTOD ECO D <br /> ( Advanced Date page —t of <br /> _-- GeoEnvironmental, Inc. <br /> 837 Shaw Road-Stockton,California-95215- (209)467-1006 - Fax (209)467-1118 <br /> Client Project Ma ger Tests Required <br /> P ne Number <br /> 67 <br /> Sa rs (Si nature) �e Invoice <br /> AGE <br /> Project Name Client ❑ <br /> p pe <br /> Sam le Ty <br /> Sample Location Date Time Water Solid Na °f ` Nates <br /> Number Description comp (arab Air Conts � <br /> Y lC�l � - <br /> c� � <br /> ete(Time <br /> e�nqu e i na re eceive y (Signature) <br /> �r <br /> Date/Time <br /> Relinquished by (Signature) Receiv by (Signatu <br /> DatelTime <br /> Relinquished by (Signature) Received by obile'Laboratory for field analysis (Signature) <br /> Date/Time Received for Laboratory by Date/Time <br /> Dispatched by (Signature) _Q 9r <br /> Lab to ame <br /> Method of Shipment <br /> I hereby a th rize th erformance of the above Indicated work <br /> Special Instructions l <br /> i <br />