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Advanced CHAIN OF6 USTODY ECO/RD <br /> Date 1� Page ofi_ r <br /> -_ GeciEn vironmental, Inc. �a DR93 _ <br /> ~„ 837 Shaw Road Stockton, Ca44forma 95215 - (209) 467-1006 Fax (208) 467 1118 <br /> Client protect Manager <br /> .�' It <br /> Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> Project Name .� - — AGE [ <br /> Pro <br /> ' Client E] <br /> Sample Location sample Type No of �` <br /> Number Description Date Time Water A,ir Solid Conts Notes <br /> Comp Grab <br /> ►�_r � 1y��.wt <br /> LXv <br /> e in�e�iy ignaReceived gnature Date[Tlmet <br /> & I�0�r <br /> Relinquished by (Signature) Received by (Signature) Dalefrime <br /> ftehnquwshed , gnat } c_. ]�„ Race e b Mo le Laba toy orf id analysis (Signature) DalelTime <br /> __� P:�Rf7i"R3�1,T <br /> - J Co Z Date/Time Rec rve for laboratory h ate/Time <br /> !J <br /> Dispatched byDWbS+ttl$WATF.�II�iI.AH�PREMVED I WUML. <br /> Method of Shipment - Labor ory Name <br /> Special instructions 1 hereby authorize t e performance of the above Indicated work <br />