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? Advanced CHAIN OF CUSTODY RECORD <br /> ' GeciEnvironmental, Inc. Date Il/ln) 9J Page __�_ of <br /> •u.ev' 4005 North Wilson Way.Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> Client C Project Manager <br /> C r� �LfY1 —F R Tests Required <br /> = c lbr <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> act Name �1 N r f r AGE <br /> Client <br /> Sample Location Sample Type <br /> No. of <br /> Num <br /> berr Description Date Time Water Air Solid Conts. Notes <br /> Comp. Grab. <br /> STccKPit # ) p by V.15 X r5R�ss <br /> STlor ► 49 2 0 <br />,i <br /> • <br />�Y <br /> F'd: <br /> ., a ms a y' Sig lureeceive y: ignature D�te/Time <br /> � . . <br /> Sinature) <br /> Received by: (Signature) <br /> Relinquished by: ( D e/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field natu <br /> analysis: Si re <br /> Y ( 9 ) Date/Time <br /> Dispatched by: (Signature) Date)Time Received for Laboratory by: Date/Time <br /> Method of Shipment: Laboratory Name <br /> Special Instructions: -I <br /> I hereby authorize the performance of the above indicated work. <br /> t J <br />