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Advanced CHAIN OF CUSTODY REC RD <br /> GeciEnvironmental, Inc. Dater' i—C):;Z Page a of <br /> 1337 Shaw Road - Stockton, California- 95215 - (209) 467-1006 - Fax(209)467-1118 <br /> ClientProject Manager <br /> Z�r P Tests Required <br /> 4 <br /> Phone Number <br /> Samplers (Signature.), J Invoice <br /> Project Name AGE <br /> r to Cl,-V" U� Client ❑ <br /> Sample Type <br /> Sample Location No of 4 <br /> Number Description Date Time Water Air Solid Conts Notes <br /> Comp Grab <br /> NAs N/?7/,C Z 117 V <br /> I <br /> o'rq r79 7V f H:3, <br /> ILD <br /> _JJ-D u Z010 ` (2 ' 171 <br /> Relinquish a ( i nature) Received by (Signature) Daterrime <br /> L 16AoQ <br /> Relinquishe gi, Received by (Signature) T Datefrime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory by DatelTime <br /> Method of Shipment Laboratory Name <br /> 1 <br /> L <br /> Spec�allnstructrons ! hereby authorize the performartca of thea ove indicated work <br />