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+•tom ata>_ t# i i� i <br /> t Advanced <br /> CHA17 COF CUSTODRECORD <br /> GeoEnvironmental, Inc Die Page of <br /> 837 Shaw Road Stockton California-95215 - (209) 467-1006 - Fax (209)467-1118 <br /> Client Project Mana r l 7 <br /> �� Tests Required <br /> ,y.� - 4. Z/� <br /> P one Number <br /> 100L <br /> ers (Signature) Invoice <br /> N AGE <br /> Protect Name r X Client <br /> Sample Location Sample Type V No of �C <br /> Number Description Date Time Water Air Solid Conts Notes <br /> Comp Grab <br /> A <br /> ", �I 2 <br /> ehnq is e y ign ure) Receivedy (Signature) te/Ti&�r J126705 / <br /> Relinq fished by (Signa ure Received by (Signature) Date(rrme <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory by DalerTime <br /> Method of Shipment Laboratory <br /> �s <br /> Special Instructions I hereby gut/halize the performance of the above indicated work <br />