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[ Advanced CHAIN OF CUSTODY RECORD <br /> GeciEnvironmental, Inc. Date ' ! Page Z ot—Z- <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> I <br /> Client a <br /> Project Manager i <br /> c f: �A��71'0 Is Required i <br /> � Phone Number 7`��� <br /> p/ <br /> Samplers (Signature) invoice, <br /> Project Name }�e f C Q h ��- p AGE <br /> Client ❑ <br /> Type ype " <br /> Sample Location SampleNo of <br /> Number Description Date Time Water Air Solid Conts Notes <br /> Comp Grab L� <br /> z <br /> f <br /> { <br /> Ke in U )d by (Sign t ecenre y TTtgnature <br /> Date/Time <br /> Relinquished by (Signature] Received by (signature) _ _l Z„q 3.ID �{ <br /> Dateffigife <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Datelrime <br /> Dispatched by (Signature) Date/Time for Laboratory y Date/Time <br /> Method of Shipment Laborat ry Name r <br /> as <br /> Special Instructions t hereb authorize the performance of the above indicated work <br /> I <br /> � � � � � � � l• �� il• r_ tiitilitt� �� �. � �_ <br />