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�---14 11111111110 M <br /> CHAIN JDE CUSTODRECORD <br /> � ; Advanced <br /> 1 (e)5 Page —3— ot� <br /> GeoEnvrronmental Inc. W <br /> Date <br /> 837 Shaw Road - Stockton, CaMornia-95215 - (209)467-1006- Fax (209)467-1118 <br /> k <br /> Client ! Q Project Manage <br /> Tests Required <br /> r-2 ne Number <br /> a`� (�©( <br /> Samplers (Signature) (�/ Invoice <br /> AGE <br /> Project Name f CL J� r �s� - - �� Client ❑ <br /> 'f— i <br /> Sample Type <br /> Sample € Location Date Time Water Solid No of Notes <br /> Number Description Comp Grab Air Conts <br /> 10 <br /> € <br /> e inqu€s e y € ature ecerve y ignature Det 1Ttme <br /> Rol€ qu€shed by (SE nature) Received by (Signature) DaterTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) � Dale/Time <br /> Dispatched by (Signature) Date/Time Received for or ory b Date(T€m11"k, e <br /> S o� <br /> Method or Shipment ! r ` / boratory Name <br /> G it _` +/'{„—(yc._— (/•r_� <br /> Special Instructions J /f 1 hereby authorize the performance of the above indicated work <br />