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Advanced CHAIN OF CUSTODY RECORD- <br /> GeciEnvironmental, Inc. Date - 3-oY Page _� of L� <br /> 837 Shaw Road - Stockton,California-95215 - (209) 467-1006 - Fax (209) 467-1118 i �t , /t t{- <br /> 1 C hl D <br /> Client 7VIa <br /> a e <br /> Tests Required <br /> Pho umber <br /> plers: (Signature) Invoice: <br /> 6 ' <br /> Project Name _ 1 r� � AGE <br /> ( ( V h Client <br /> Sample Location Sam y <br /> Number Description Date Time Water Solid No. of Notes <br /> Air Conts. �� <br /> Comp. Grab. <br /> / <br /> d2a, <br /> .ta- :]L I 13K <br /> r <br /> 63 <br /> - it 11 <br /> - b 6 Ival <br /> e mq s y: ( ,gnatureReceived y: (Signature) <br /> Date/Ti <br /> Rei wished by: (Signature) <br /> ignature) Received by: (Signature) d <br /> Date/Time <br /> Relinquished by: (SReceived by Mobile Laboratory for field analysis:(Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboritory <br /> 't../ DateRima <br /> Method of Shipment: Labor I ty me L I r 4 <br /> Special Instructions: I her authorize the perfo mance o�above indicated work. <br /> f j <br />