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Advanced CHAT CUSTOD4 TECO D <br /> " GeoEnvironmental, Inc. Date Page 1f <br /> 837 Shaw Road- Stockton, California 95215- (209)467-1006-Fax (209)467-1118 <br /> Client P rotecL Mana <br /> Tests Required <br /> I <br /> P umber / <br /> ars {Signature) invoice <br /> Project Name AGE <br /> n <br /> Client ❑ <br /> - P(&'� I <br /> Sample Location Samp a Type Solid No of <br /> Number Description Date Time Water Ali Corns Nates <br /> Comp Grab i <br /> 611104 1.2 771 <br /> I <br /> T <br /> elf u e rgna Receivedy (Signature) Ri t <br /> tl� I <br /> Relinquished b (Sig azure) Received by (Signature) Date/Time „jj� <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Tima <br /> Dispatched by (Signature) Datemme Recev r or DatelTime <br /> Method of Shipment j Laboratory e <br /> Special instructions thereby i th rize t perfor ante of the above indicated aiork <br /> L <br /> 1 � <br /> 1 <br />