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[ Advanced CHAIN OF CUSTOD}Y REC D <br /> Date - Z ,�-7Pa e I of <br /> GeciEnvironmental, Inc g <br /> 4005 North Wilson Way Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> Clientt Project <br /> j/6 Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> i <br /> Project Name Name <br /> Client F]� AGE <br /> r <br /> Sample Location Sample ype No of <br /> Number Description Date Time Water Air Solid Conts Notes <br /> Comp Grab <br /> 1�W3~ Monti-QHAP WZ11 <br /> o 0 p <br /> M5 <br /> MvJ3 30 o <br /> ~ � 1 <br /> S <br /> N\ /! \ 1Y <br /> Mw3 -3 <br /> e r is ed by ( nature eceive y ignature Dateffeme <br /> S 14(vOAP{J �0 <br /> Relinqutshe Td by (Signature) Received by (Signature) DatelTrme <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) I Vale/Time <br /> I <br /> Dispatched by (Signature) Date/Time ecew d for Laborator y , Date/Time <br /> Method of Shipment Laboratory Name <br /> A. O,,, c, - ml e- <br /> Special Instructions l hereby authorize the performance of the above indicated work <br /> I <br />