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Advanced CHAI O USTODY RECORD <br /> --= GeoEnvironmental, Inc. Date TPage 4 if <br /> 637 Shaw Road -Stockton, California-95215-(209)467-1006- Fax (209)467-1118 <br /> Client Pr ect Manager <br /> Tests Required <br /> hone Number <br /> a Pt6rs (Signature) Invoice <br /> Project Name C �S AGE <br /> Client Q <br /> Sample Type <br /> Sample Location Date Time Solid No of <br /> Number Description Water Air Cants Notes <br /> Comp Grab <br /> ! -/ --O 16511 .� <br /> MIU "5".06 11 / 7 �- <br /> V IL )A <br /> Relinquished K fig ature eceive y ignature DalefT e <br /> Relinquished by (9ignatureQReceived by (Signature) D elTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Dateffime Received for Laboratory J Datefrim <br /> r �J <br /> Method of Shipment LabKratory <br /> oau A), <br /> 4 <br /> Spac+al%natruct+ona 11A El 0 r- J hereby arize t performance of the shove indicated work <br />