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Advanced CHAT OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Dane r1 a Page _ of <br />- 837 Shaw Road- Stockton, California 95215 209 467-1006 - Fax 209 467 1118 <br /> Client Pro e ct Manager <br /> Tests Required <br /> }gone tiumber <br /> W7 mv <br /> —__ S lers (gnat re} Invoice <br /> I- Project Name n AGE 21 <br /> - .1 ��� Cc �! Client ❑ <br /> Sat <br /> Sample Location er Notes <br /> Type Solid <br /> Wate <br /> Date Time No of � � <br /> Number Description c�mrab Air Conts <br /> 111A16 125-7 <br /> [ r/ - <br /> �I <br /> /30G 21 <br /> - <br /> oil igy is e gn tui Received y (Signature) /Time 'r�] <br /> Ntz -7 <br /> RalingOshed (Signa ute) Received by (Signature) pate/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for held analysis (Signature) � DatetTime <br /> - pispair hed by (Signature) DatelTime fiec Laboratory,byD /Time <br /> zas�3 v <br /> Methori of Shipment g Labora N <br /> (d e j <br /> e/-7/t L - K- A r 4P ��0� <br /> Special Instructions 1 l / —eby au ize the formence f the above indicated work <br /> APPRnPRIATE <br /> READ SPACE AF351rNT CONTAWERS <br /> DECITLORINntf;D IN LA i�SER VEE IN LAB <br />