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� � 1• i� � � � � � � � � � ■■� 1_ fffii� ffi�� � <br /> HA CUSTODY RECORD <br /> l <br /> Advanced CHAIN OF CUS RD O O <br /> GeoEnvironmental, Inc. Date 6 v�age °i - <br /> 837 Shaw Road,Stockton, California- 95215 - (209) 467-1006 Fax (209)467-1118 (' q <br /> Client aProle Manager <br /> 6L TO �'`r F�I��� � Tests Required <br /> Phone Nu r <br /> Samplers (Signature) ,�� Invoice <br /> Project Name AGE <br /> c A8 Cid``'A Client ❑ <br /> Sample Type <br /> Sample Location Date Time Water Solid No of ►� Notes <br /> Number DescriptionDate <br /> Grab Air Conts `v <br /> w - <br /> T <br /> e anqi e y ignature Receivedy rgnature Date/Time <br /> STC) -TA-7- <br /> Relin uished 15y (Signature) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> i <br /> Dispatched by (Signature) Date/Time Received for Laborato by DatalTime <br /> Method of Shipment abof air Ngr�r <br /> Special Instructions i hereby auf rtze the performance of the above indicated work <br /> i <br />