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• STODY ECORD <br /> � 0 Advanced CHAIN OF CU <br /> - Date I Z 11 a 1 Page -_ — of -3 <br /> GeoEnv�ronmental, Inc <br /> 837 Shaw Road - Stockton, California-95215- (209)467 1006- Fax (209)467-1118 <br /> Client --�d '(VProject Manager <br /> Tests Required <br /> ,r.-` CV 11 c.�- <br /> Phone Number <br /> ,'(0q - Ll f I()o�. <br /> Samplers (Signature) Q Invoice <br /> Project Name AGE <br /> LN <br /> To P , ���� J .� �. Client E]� V <br /> Sample Location Date Time Sample pe Solid No of <br /> Number Description Comp Water(arab Afr Conts ,L� 4 Notes <br /> i11Ui x . <br /> 'JL/IzIto 1 1101X J'X X\ Al <br /> t13/ 12.11ui 3 11`Iy X IX, <br /> ZI#UI O-) jz-fjTdl 1?oe A X x K <br /> X x 'X <br /> �JruI;311Z110i t�J jZ-11-ai 11 l� X X <br /> Re e •( i nature Received y gnature f)atelTime <br /> �/-Z /V/01 /fes Ly 1 <br /> k ujshed by (Signature) Received by (Signature) DatefTrm <br /> 12-12--bl a7� <br /> Relinquished by (Signature) Received by Mobile Laboratory for held analysis (Signature) DatelTime <br /> Dispatched by (Signature) Datef ime R erve or Laborato b Datefrrme <br /> 1/.x ( G� qC�C <br /> Method of Shipment Laboratory Name <br /> Special Instructions I hereby authorize the performance of the above indicated work <br />