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Advanced CHAT OF CUSTOD*ECORD <br /> I _ <br /> GeoEnvironmental Inc Date page of� <br /> 837 Shaw Road - Stockton, California- 95215- (209)467 1006 Fax (209) 467-1118 O w <br /> Client Pro e ane Tests Required <br /> f}e Number <br /> &6:7 ln�(a <br /> rs (Signature) Invoice <br /> AGE <br /> Project Name _ Client ❑ <br /> Sample Location Sample Type Solid No of Notes <br /> Comp crab <br /> Date Time Water G <br /> Number Description Air Conts <br /> a{ <br /> ell q e ( k nat } ece+ve y tgnature D telTrme <br /> ILI <br /> lmquish d by (Signature) Received by (Signature) Date/Time <br /> Relinquished by (StIgnature) Received by Mobile Laboratory for held analysis (Signature) Date/Time <br /> Dispatched by (Signature) DatelTrme Received for Laboratory by pate(rr <br /> Method of Shipment Labora Nam <br /> Special Instructions I hereby auth z the pe r�ance of t e above indicated work <br />