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• O <br /> Advanced CHAIN OF CUSTODY RECORD <br /> Date 0 5-17 -Z/00 Pa e <br /> GcoEnvironmental, Inc aC�� of <br /> 4005 North Wilson Way Slocklon,California 95205 (209)467 1006-Fax(209)467-1118 <br /> Clientf-G� er Project Manager <br /> Tests f3equfred <br /> Phone Number <br /> z01 4-67-100 <br /> -- Samplers (Signature) Q� Invoice <br /> Project Namej/ ��� r S AGE K <br /> Client ❑ <br /> Sample Location DatSample Type sy <br /> Number Description e lime Water Solid No of Notes <br /> �- Comp Grab Air C4ni5 <br /> I= <br /> 30 — <br /> P- 3f— K/ <br /> n - <br /> vb�s <br /> 3 tot <br /> 4L <br /> 3 Z - 00 i� X11' VOA5 <br /> Ir Inqui—'ishie J b rgnaturv� accrue y tpnalure <br /> Date/time <br /> 17A ( vv <br /> iteHVished by (Signature) Received by (Signature) Date/time <br /> figlrnqurshed by (Signature) flecewed by Mobile Laboratory for field analysis (Signature) DatelTime <br /> Dlspatahod by (Signature) Date/Time Rocred for Laboratory by <br /> t pate/Time <br /> V ti <br /> y t` <br /> Melhod of Shipment Laboratory Name <br /> Special instructions ! /} I 1 I hereby authorize the pe►for ante of the above Indicated work <br /> �. Y -�- <br /> r <br /> r. r <br />