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IE ORD <br /> Advanced Date <br /> OF CUSTODY C <br /> GcoEnvirQ11111cntal, Inc. Date-2-2-15-7 -W ,.90 of <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> 145fv3 ' o <br /> Client @ Proje nag�r Tests Required <br /> /v <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> AGE [J� <br /> Project Name (�f (�J��� �,�, Client ❑ <br /> Sample Location Date Time Sample Type Solid No. of / 1 Notes l <br /> Number Description Comp.w teGrab. Air Conts. t <br /> r 86130 r <br /> 1►>j E �q.(a 86131 <br /> t <br /> I <br /> e pq a y: ( inn t r ece v y: ignature r1t� ^� •1�1� rpm <br /> • C&&I 019.2 /vf 1 Dale/Time <br /> Relinquished by: (Signature) ved by: (Signa re) <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Dale(Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Date/Time <br /> Me d o hipm JV111L11 Flh <br /> boratory N e <br /> Special Instructions: _ " ereby autho ize 1 e performan a of the above Indicated work. <br /> /W/ y <br /> iii ii <br /> li ! l <br /> �� tib. ..�' r l•, , , <br />