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�� •�� � �� �� t_ t� 1111111111 t� !■�_ � tti>♦ fa• � � � � � � <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeciEnvironmental, Inc. Date d 1-,�7-G 3 Page __.L__ of <br /> 837 Shaw Road-Stockton, California-95215 - (209)467-1006 Fax(209)467-1118 <br /> ClientProject Manager <br /> S, e rr°- ('✓"^'�y�r Tests Required <br /> Phone Number <br /> 967 - /QV Cir <br /> Samplers (Signature) invoice <br /> Project Namef r AGE <br /> 5;ecru Ljyv�ber X � Client ❑ <br /> Sample Location Sampl ype <br /> Number Description <br /> Date Time Water Air Solid Cants Notes <br /> Comp {arab <br /> vq-17-6100 <br /> X <br /> o 1. a T(\ Ue"+ 6ly-a7vl 1(UY- X � <br /> Re, e y (Signature) ece ve y ignature <br /> Date/Time <br /> Re! cashed b (Signature) <br /> q y ( 9 1 Aeceived b ignat &'t*"fTTIma--7 me <br /> Relinquished by (Signature) LLL)—L lRecalved by Mobile Laboratory for field analysis (Signature} - <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Date/Time <br /> Method of Shipment { laboratory Name <br /> Special Instructions I hereby authorize the performance of the above indicated work <br />