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jL Advanced CHAIN OF CUSTODY RECORD <br /> GeciEnvircinmental, Inc. $ Date "(� G�' Page Yof <br /> 637 Shaw Road - Stockton, California- 95215 - (209) 467-1006 - Fax(209) 467-1116 <br /> Client Pr91ect Manner <br /> �� SG Tests Required <br /> Phone Numbe <br /> S fix)✓� <br /> Sam lers: (Signat �� o <br /> r / (Signature; ( n �� Invoice: <br /> Project Name W' � � � �( �� AGE <br /> C y Client <br /> Sample Location Sample Type <br /> Date Time Water Solid No. of <br /> Number Description Air Conts. Notes <br /> Coin p. Grab. <br /> I-1c �n <br /> 301 <br /> Or <br /> l4 c L r-> <br /> elin ed by: ( igna� ecewe —y ignature <br /> Date rime <br /> Relinquished by: (Signature) Received by: (Signature) CI`?J7 G'+7 [ J <br /> Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Receivad for Laboratory by' <br /> Date/Time <br /> Method of Shipment: Lab t Name �y V <br /> Special Instructions: I hereby aut�ize thee'vert, ma of the above indicated work. <br /> L_�/ <br />