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i i i 1• i i i i i i i a• �� imiiiiiii t 111111111M1111 1 <br /> • CHAT F CUSTODY ECORD <br /> � Advanced <br /> GeoEnvironmental, Inc. Datta page "'L- o� `Z <br /> 837 Shaw Road- Stockton, California-95215- (209)467-1006- Fax(209)467-1118 0 01 <br /> Client Pro ct Manager <br /> Tests Required <br /> Phone umber <br /> � 0n.4 <br /> Sam s (Si nature) Invoice <br /> Project Name AGE ' <br /> Client ❑ <br /> Sample Type <br /> Sample Location I Date Time Water Solid No of Notes <br /> Number Description comp crab Air Conts <br /> f9 0 <br /> e ini e igrt r Receivedy (Signature) atalTrme <br /> Relinquished by (Signature) Received by (Signature) Dale/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) <br /> DatelTime <br /> Dispatched by (Signature) Date[Time Received for Laboratory by Date[Time <br /> Method of Shipment Laborato am <br /> Z,-6 <br /> Special instructions I hereby auth zs he performance of the above indicated work <br />