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j Advanced CHAIN OF CU <br /> STODY RECORD <br /> Dace ZL��o - Page GeciEnvironmental, Inc. fof <br /> 837 Shaw Road Stockton, California- 95215 - (209)467-1006 - Fax (209) 467-1118 <br /> Client Project �In or i �.� 1,1� �Q,v Tests Required <br /> V1 <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> Project NameAGE Nr <br /> 5 � h � ' Client ❑ <br /> Sample Type <br /> Sample Location Solid No.of 'v Notes <br /> Date Time Water C <br /> Number Description Comp. Grab. Air Conts. A. <br /> e q is ignature ecerva y: ignature ate me <br /> 4-5 10 Z 1400 <br /> RelinquishYd b i nature) Received by: (Signature) Datef ime <br /> Relinquished by: (Signature) Received by Mobiie Laboratory for field analysis:(Signature) S1,AT Date[Time <br /> Dispatched by: (Signature) Date►Time Received for Laboratory by. D e/Time <br /> 42 0 4, 16" <br /> Method of Shipment: Laborator Name <br /> � T(-1- <br /> Special instructions: I here uthorize the performance of the above indicated work. <br />