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I_ I_ fffffffffffll i♦ � � <br /> 044 <br /> CHAT O <br /> N F CUSTOD RECORD <br /> Advanced <br /> --- GeoEnvironmental, Inc. Date r Z-�'�" Page z of <br /> 837 Shaw Road-Stockton, California-95215- (209)467 1006- Fax (209)467-1118 <br /> Client `s ftv Project Manager Tests Required <br /> bi;th OA <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> Protect Name AGE 0 <br /> Sample Type � <br /> Sample Location Date Time Water Solid No of Notes <br /> Number Description Camp Grab Air Conts <br /> VW56AW-iA 111Q .5-6 <br /> 1 J 0 C- <br /> RU <br /> - <br /> 1�/�� U� <br /> e is e y (Signature) Received y ignature Dater ime <br /> Fireffinquished by (Signature) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobil*Laboratory for field analysis (Signature) 4e, DatelTime <br /> Dispatched by (Signature) Date[Time Received for Laboratory by pat9fTime <br /> Method of Shipment Laboratory Name <br /> (".j o�i�cn, h� C/ <br /> Spacial Instructions I hereby authorize the performance of the above indicated work <br />