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j Advanced f CHAIN OF CUSTODY RECORD <br /> Date 7 -iL/`0? Page --/ of <br /> _ = GeclEnvironmental, Inc. �tiU <br /> +' 4005 North Wilson Way-Stockton,California-95205-(209)467-1006 Fax(209)46 - 118 <br /> Client r Project Mar}ager <br /> h Tests Required <br /> Phone Number <br /> t I <br /> Samplers (Signature) Invoice <br /> Project Name /, �A <br /> a <br /> AGE <br /> [/U Client ❑ <br /> Sample location <br /> Date Time Water Sample Type Solid No of Notts <br /> , <br /> Number Description Comp Grab Air ContS r <br /> 140. 92520 W <br /> Trip— -; 12, 25 - - - - <br /> Na, 92521 <br /> e+nqu s e y +gnalure eceive y +gnature `7 Date/Time <br /> r 22- l3� <br /> Relinquished by (Signature) Recelved by (Signature) WASIB i +ilrp 1114 R <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) <br /> Dispatched by (Signature) Date/Time Received lot Laboratory by ,{ ,l: }J�li »� �' 21+,�,LIrDate/Time <br /> Method of Ship me yy // p II11� Tab oralor ems�y� � <br /> Special Instructions „�/ I hereby authorize the erlormance of the above Indicated work <br /> �" t <br />