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00e� G 7� S <br /> CHAIN OF CUSTODNE <br /> CORD <br /> Advanced Date U S Page of <br /> GeciEnvironmental, Inc <br /> 837 Shaw Road - Stockton, California 95215- (209) 467 1006 Fax (209) 467-1118 <br /> Client �1 ! Protect Manager Tests Required <br /> Tm 6AC'C <br /> Phone Number <br /> J � <br /> Samplers (Signature) lrnafce <br /> ' AGE <br /> Prosect Name 77 <br /> Sample Location Sample Type No of <br /> Date Time Water Solid � Notes <br /> Number Description comp Grab Air Cants <br /> EW <br /> A qql <br /> Re a ignature) i ecqivp rgnature D &!Time <br /> Dale/1i e <br /> Rebriquished by (Signature Received by (Signature) Y <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatelTlme <br /> Dispatched by (Signature) <br /> DatelTima Received for Laboratory by Datel7)ma <br /> Laboratory Name <br /> Method of Shipment 0 <br /> I hereby authorize the performance of the above fnd+afted work <br /> Special Instructions <br />