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j L Advanced CHAIN OF CUSTODY RECORD <br /> GeciEnvironmental, Inc. Date -5 3 Page I Of <br /> 837 Shaw Road - Stockton. California- 95215 - (209) 467-1006- Fax (209)467-1118 <br /> Client £ Prol Manager <br /> <�-- C Tests Required <br /> Phone Number I �p <br /> Samplers: (Signature) invoice: <br /> v <br /> Project Name �!, ' 1 �E j I v — y AGE <br /> Client <br /> Sample Location Sample Type <br /> Number Description Date Time Water Solid No. of ! Notes <br /> Air Conts. �. <br /> Comp. Grab. <br /> 1 - L %z r1 z &X I � -S013 I C 6 1 k <br /> ` -s-o s la `iU X —1 X X X <br /> Relinquished y: ignature ecelylgnature <br /> CDate/Tima <br /> Relinquished by: (Signature) Received by: (Signature) `+ T /Y - <br /> 1 I I 1 �T Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) 111 Date/Time <br /> Dispatched by: (Signature) Date/TimeReceived for Laborato b <br /> ry y' Date/rim <br /> Method o/Shipment: � <br /> �Uln) Lab tory yema <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br />