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Advanced CHITIN OF CUSTODY RECORD <br /> GeoEnvironmental, hnc Date `�' Page Z of <br /> 837 Shaw Road- Stockton, Callfornia- 95215- (209)467-1006 - Fax (209)467-1118 <br /> Client �e- Project Manager Tests Required <br /> Motto Number <br /> 2-,0 -/&)6- y <br /> Sampl rs, (Slgnatu e) Invoice <br /> AGi= .GM <br /> Project Name Client ❑ <br /> � <br /> Sample Location Date Time Sampype Solid No of Notes <br /> Number Description Water Air Conts <br /> camp Grab <br /> 7BB30 <br /> >t��9� �� , � t► ll� �C. � 7BB31 <br /> 7Re i is e y ignatur ece ve y ignalure Q Date171 <br /> FAIby (Signal re) fieceivad by (Signature) <br /> Relinquished by (Signalure) Received by Mobile Laboratory for field analysis (Signature) DalalTrma <br /> Dispatched by (Signature) Date/Time Recaive for L ofatorytq D tafrrm <br /> U. � c0/4 Q/ 1 � <br /> Method of Shipment f Lab 'at'or/yName <br /> Cfr � �- eroby au11H r a the parlor L he above indicated work <br /> Special instruction ti PR���Et�Ux(IOP,� <br /> �(?L�CON10,10 DDnrtnn1 arc / <br /> rD sPac aeSN _ c �Al' s� r <br />