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ilk <br /> t Advanced CHAIN QF USTODr'RECORD <br /> GeoEnvironmental, Inc. Date 1 Page 2-o <br /> 837 Shaw Road - Stockton, California-95215- (209)467 1006- Fax (209)467-1118 rfl <br /> Client Project Manager C! fg l <br /> Tests Required <br /> P d ber �✓�-- <br /> (Si ure) U U Invoice <br /> Project Name i AGE <br /> (, ( kl <br /> Client ❑ <br /> Sample Type <br /> Sample Location Date TimeNo of <br /> Number Description Water Solid Pur Conts Notes <br /> Comp Grab <br /> -Do - 5 <br /> A J& 4k 1 3 h 1 011 <br /> e inqu e y i na re Receivedy (Signature) <br /> XY <br /> j tm <br /> MAA�14 <br /> 1 Relinquished by (Signature)tj Received by (Signature) '/Dalertimo <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DalelTtme <br /> Dispatched by (Signature) Date(Trme Received for Laboratory bDatetTime <br /> Method of Shipment L Drre� <br /> s <br /> o—etiaa 4- M��L <br /> CSpecial Instructions iv I hereby auth nze Sha pe or ante f the above indicated work <br /> I <br />