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( Advanced <br /> CHAIq OF CUSTODOECORD <br /> GeoEnvironmental, Inc. °a< Page of <br /> 837 Shaw Road-Stockfon, California -95215- (209)467-1006 - Fax (209)467-1118 r 2 7 2, <br /> Client l '�to,� Project Manager Tests Required <br /> VOnna Sexy. <br /> Phone Number [/, , <br /> a09 -Li& --too t/ <br /> Samplers (Signature) ti� Invoice <br /> AGE N <br /> Project Name Co UY)4 rV C [u,f_ fo cIA , „[� `�G� Client ❑ <br /> Sample Type � !� <br /> Sample L cation Solid No of Q N Notes <br /> Number Description <br /> Date Time Water �r Conts <br /> Comp Grab <br /> 65 035 <br /> z7I i L --I- J.- A <br /> Z"tnquished <br /> n a gnatur ) Receivedy (Signature) {latelTi e <br /> _ 5 27 0 <br /> by (signature) Received by (Signature) STA [ Dateftime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) 1 Date/Time <br /> Dispatched by (signature) DatelTime Received for Lab7N, <br /> Date/Tim <br /> _ 9 <br /> � <br /> Method of Shipment CAL- <br /> I <br /> y <br /> L © �-N L Laboratory Name lf <br /> 1 hereby a rize t e performan o the above indicated work <br /> Special Instructions <br />