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Advanced CHAIN OF CUSTODY RECORD <br /> GeclEnvi1-011mental, Inc. <br /> `,- Date fZ_� Page of <br /> of Nor7hrr7r Crrlifnndca <br /> 1803 West March Lane,Suite A-5locklon, C-Ilifornia -95207-(209)956-0264•Fax(209)956-0700 <br /> � 41 ACs at O <br /> Client. Project Manager <br /> Tests Required <br /> Phone Number <br /> Samplers: (Signature) , <br /> Invoice: <br /> Project Name AGE [.7f <br /> Client ❑ <br /> lr C' <br /> Sample Location ample Type <br /> Number Description Date Time Water Air Solid C o. of <br /> Notes <br /> Comp. Grab. OntS. <br /> 1Z--� f� r'47-�� 1� i,a � � � 72171 <br /> ✓ 72172 <br /> rz� � ,ins -- - <br /> ✓ ✓ �-C�/,�Q.. 7217'% <br /> Z 17�� t1 ��' ✓ s ✓ 72174 <br /> r tw5 I -! 7-7ccz- !z 72175 <br /> 5 <br /> e mgtilsIT <br /> ZI y: ( ignalurc) <br /> ecer y: ( ignatur X02` /S 4F 4/ Dale/Time <br /> Relinquished by: (Signature) <br /> e ved by: (Signa re) Date/Time <br /> Relin by' rgnature) } Roc ved by obile Laboratory for field analysis: (Signriluro} //�� ) <br /> (y c�i�a.1TH <br /> 7' Dale/rime <br /> Diapal Date/lime Received Tor Laboratoryb T I <br /> r y� DetelTime <br /> Method of Shipment:_? <br /> J� Laboratory Mame <br /> _ 1~"7- lJ. lb�-� 1�'^t' (�CG/� ��,►.Q,! SeAl,-�l � St <br /> Special inalruoii ns: <br /> / ✓) ./ / )� n ��� �} `� t hereby aulhorize the performance of the above Indicated work. <br />