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{ Advanced CHAIN Ely <br /> USTODY RECORD <br /> GeoEnvironmental, Inc. Date �` Page : -- Z- <br /> =� -, of <br /> 837 Shaw Road-Stockton, California-95215 - (209)467-1006- Fax (209)467-1118 <br /> Client f Project Man er <br /> Ail <br /> Tests Required <br /> Phon Number <br /> mpiers (Si azure) Invoice <br /> Project Name AGE,.g4- <br /> 0 Client ❑ <br /> Sample Location Sample Type No ofa <br /> Number Description Date Ti Water Air Solid Corlts 'V Notes <br /> Comp Grab <br /> lt,JA 12-31 g1= <br /> / -- /-� . <br /> Ail 910 <br /> z-�3 -�- 3 <br /> e q is y na ecelve y ignature <br /> 1 Date/Time <br /> Relinqu—ishIld by rgrra ) ®1 Ca? <br /> Received by (Signature) DatelTime c°"4 <br /> Relinquished by (Signature) Rece+ved by Mobile Laboratory for field analysis (Signature) Datefrime <br /> Dispatched by (Signature) Date/Time no for Lab rat ry b - DatelTims <br /> Method of Shipment /i La Drat ry ame <br /> Special instructions --4 13�" <br /> I hereby author 1 par mance of the above Indicated work <br /> �1 <br />