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CHAIN OF CUSTODY RECORD <br /> S3Advanced / t Page GeciEnvironmental, Inc. ,Date — g of <br /> 3 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118- % /` �p J4 <br /> Client Project Manager / <br /> Tests Required <br /> dclv S Phone Number <br /> Samplers: (Signature) Invoice: <br /> Project Name AiClient ❑ <br /> Sample Type <br /> Sample Location Date Time WSolid No. of Notes <br /> Water Number Description Air Conts. <br /> s. <br /> Comp. Grab. <br /> ?)_3 <br /> 10 <br /> S 1/gib <br /> D e/Ti <br /> Re qs a y: (Signs tu ecerve ign61 , 'f <br /> w <br /> :. e1/ My K4-4Y 7i 7 <br /> Relinquished by: (Signature) _ Aecei �d by: (Signature) <br /> Date ime _ <br /> Relinquished:by: (Signature) 'Received by Mobile Laboratory for field analysis: (Signature) / Date/Time <br /> Dispatched by: (Signature) Date/Time . Received for Labdratory by: - DateMrms <br /> .Method of Shipment: Laboratory Name <br /> fJ7kvv-wt.-� <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br />