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I i <br /> ( Advanced CHAIN 9F <br /> �CUSTODY RECORD <br /> - GeciEnvironmental, Inc <br /> Date !/? } Page of <br /> 4005 North Wilson Way-Stockton,California 95205-(209)467 1006-Fax(209)467 1118 <br /> ClientPA r , 0 <br /> Pro ect Manager + Tests Required <br /> P/h6ne Number <br /> vLLJ r �7—l l�'✓ l� �� <br /> c <br /> r SamplOrs (Signature) "` Invoice <br /> Project Name <br /> a <br /> AGE <br /> Client ❑ <br /> Sample f Location Sample Type No of ' <br /> Number Description Date Time comp Water Air Solid Conts Notes <br /> FL X- <br /> einqu s y ( ignature) Receivedy rgnature DatefTome <br /> Relmq s e y ( gnature)i Recewed by (Signature) Date[Time <br /> Relinqumhed by (Signature) Received by Mobile Laboratory for field analysis (Signature) / Date/Time <br /> Dispatched by (Signature) Date/Time Received for laboratory by Datefrime <br /> Method of Shipment f Laborato� : <br /> N 9 t <br /> Special Instructions I�y authYorize the perforrri <br />