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�LL(� CHAIN OF CUSTODOECORD <br /> X Z Advanced _ _ <br /> L r� <br /> P <br /> GeoEnvironmental, Inc Date r age of <br /> 4005 North Wilson Way Stockton,California 55205 (209)467 1006 Fax(209)467 1118 <br /> Client f �G Project Manager <br /> � I � f�� Tests Required <br /> 07 ) <br /> Phone Number <br /> Samplers (Signature Invoice <br /> Project Name �f //Gr� �����..�� Chen Q <br /> Sample LocationWoTime <br /> Sample rType Solid No of Notes <br /> Comp Grab <br /> Number Description Air Conts / ti <br /> h L/-q ' 7/ C� 1 L 14 <br /> r Ll <br /> 4, Oil <br /> cfZDate/Time <br /> ee i ( ,gna1 ece+ve y ( ignature ; — 1 '11Y J 00 <br /> Relinquished by (Signature) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> s <br /> Dispatched by (Signature) Date/Time �J;::iv�ed�Ir Laboratory pfr ti Date/Time <br /> Method of Sh+pmen! h Labor tory Name <br /> Special Instructions I hereby authorize the per[orma ce of the above indicated work <br />