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CHAIN O CUSTODY RECORD <br /> Advanced C A <br /> e v'ronmental Inc. �, Date page � -- <br /> `, G oEn �8� to ckL_,,1�- _ <br /> 837 Shaw Road - Stockton, Californta- 95215 (209)467-1006 Fax (209) 467-1119 <br /> Client Project an ger Tests Required <br /> V �ee- <br /> Phone Number rf <br /> Samplers {Signature) Invoice <br /> t <br /> AGE <br /> Project Name / � ' ,, ' Client ❑ <br /> !` <br /> Sample Location Sample Type <br /> Sam Date 'time Water Solid No of <br /> Nc*— <br /> l' <br /> Number Description Comp f3rab Air Cons <br /> 8335 <br /> x X <br /> 83353 <br /> X 83354 <br /> 'T-T- <br /> e inqu Received by gnature DatelTime <br /> Relinquished by (Signature) Received by (Signature) Date(Time <br /> Relinquished by (Signature) Received by Mobile Laboratory lot field analysis (Signature) Dateffime <br /> Dispatched by (Signature) Date/timeReceive for Laborat ry by DatelTime <br /> Method of Shipment _ Laboratory Name <br /> W <br /> Special Instructions f �j ^rnl,1 ! l in�il (1Ti�c j 1 hereby au orize he performance of the above Indicated work <br /> p <br /> �fJ <br />