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{ Advanced <br /> CHAIN OF CUSTOD*ECORD , <br /> GeciEnvilronmental, Inc DateZ Page o� <br /> 837 Shaw Road- Stockton, California- 95215 - (209)467-1006 Fax (209) 467-1118 <br /> Client Prolp,Ma ager Tests Required <br /> M <br /> Number <br /> Sa (Sign ure) Invoice <br /> AGE E ' <br /> Project Name <br /> Client ❑ <br /> SampSample Location Date Time Water <br /> Type $olid No of \ Notes <br /> Number Description Air Conts / <br /> Comp Grab <br /> lJ <br /> e inqui a y ( g a re) ecewe y (Signature) IetTupe + <br /> 1i G <br /> Relinquished by (Signature) Received by (Signature) Da 1Trme <br /> Relinquished by (Srgnateue) Received by Mobile Laboratory for field analysis (Signature) Datef ime <br /> Dispatched by (Signature) Date/Time Recery I} orat yatelTrme <br /> 1 D� [rq <br /> Method of Shipment Laboror Nam <br /> Special Instructions ii i hereby authorize the p rlorman a of the above indicated work <br />