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CHAT ` <br /> Advanced N OF CUSTOD ECORD <br /> GeoEnvironmental, Inc. Date 0 Z ��Y _ Page j Of <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006 Fax(209)467-1118 <br /> Client Project t�f� � Prct Manager Tests Required <br /> rrv\ jl <br /> Phone Number <br /> 2.,c -V1 7-/4,c, , <br /> Samplers (Signature) ��, Invoice <br /> Project Name AGS <br /> S"errA l-vM bc'— ` Client <br /> Sample Location Date Time Sample Type No of <br /> Number Description <br /> Water IAir Solid Conte <br /> 15 �~ Notes <br /> i f <br /> Comp Grab <br /> bor r nc M w'7 <br /> Mev ' +� i c J5r�(� z�-� '�r� 94080 <br /> 4 <br /> ' 911 82 <br /> �p <br /> tl i SoF'ec Ct <br /> quis a y ( ignature ecgive yigna ure 7�'\'�''� Datefrime <br /> \�j � `r✓ �S iv` <br /> Rel�quished y (S alure) t'� <br /> Received by (Signature) Dale(Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for held analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Date/Time <br /> Method of Shipment Laboratory Name <br /> ��\CCXNIG 7 CA JIP <br /> Special instructions RESERVAT1, I hereby authorize the performance of the above indicated work <br /> GOOD CPADITICIN r '-0P: r '� <br /> ail <br /> HW SPACE ABSENT� C(NTAINEAS �?'�'� <br /> ail <br /> by CAI 01"V,c hignt <br />