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i 1• i i i i i i i i ! ! ! �� i s f� t� ififit� <br /> Advanced CHAIN OF CUSTODY RECORD <br /> [ ff <br /> GeciEnvironmental, Inc. 2 ( Dace jr z2 Page 1 of� <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1119 <br /> Client F ciT,1 cliEsiton <br /> Project Manager �� Tests Required <br /> C £ �. <br /> Phone Number <br /> Samplers (Signature) W Invoice, <br /> Project Name tt (, rt t AG <br /> � Clientt <br /> ❑ <br /> Sample Location Sample Type No of <br /> Number Description Date Time Water Air olid Conts Nates <br /> Comp (arab <br /> ANiaL- <br /> c012191VI Di+C.N ; N44A La��ss 54621 <br /> I �� � � �. ►I�u-� r1 � �5 ���,,� <br /> e inqu ad by (Signature) ece ve y gnature Date(Time <br /> Relinquished by (Signature) Received by (Signature) baterTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Daterrime <br /> Dispatched by (Signature) Date/T�me Rec i e for LabMatory b Date/Time <br /> Method of Shipment _ LaboratoryOlNlams <br /> Q P{; (' r ML � � <br /> Special Instructions UP0oole PRESFRV tiT10,'A I hereby authorize the performance of the above Indicated work <br /> GOOD wunlTol to APP <br /> fl,AD SPACE ABSENT— CON IiAERS,.,,, K <br />