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l� Advanced CHAIN F CUSTODY RECORD <br /> GcoEnvtronmental, Inc �� sr-1��G� � � Date a Page J— of <br /> 4005 Norih Wilson Way-Slocklon,California-05205 (209)467 1006 Fax(209)467 1118 <br /> Client <br /> Project Manager <br /> Tests Required <br /> T/b(I ("L&e8a4-- <br /> P ne Nu ber <br /> �— 4 4 ooh <br /> Sar pe (5 natur } Invoice <br /> Project Name ! AGE ,� <br /> Client ❑ <br /> Sample Type ,1 <br /> Sample Location Date Time Water Solid No of Notes <br /> Number Description Air Conts t I <br /> Comp Grab <br /> �-. <br /> 39221 <br /> r r <br /> 3`1 <br /> #,_• it <br /> —"a tiis—rih'fc ry Igpalurel ecerva y rgnature i]alelTima <br /> !Iola qulshod by (Signature) Received by (Signature) Data/Time <br /> Raluiqulshed by (Signature) Received by Mobile Laboratory for held analysis (Signature) r.y Date/Time <br /> /- <br /> Uispatched by (Signature) OatelTrme Received Ior Laborato b UalelTlme <br /> G�0 Z /4 <br /> La tolory No e <br /> Method of Shipment C��� CeJ(� ,gQ L � � <br /> lie, <br /> Special Instructions I hereby authorize the pert rmance or the above indicated work <br />