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L <br /> Advanced CHAIN OF CUSTODY R CORD <br /> GeciEnvironmental, Inc, ants Page z of �- <br /> 837 Shaw Road- Stockton, California 95215-(209)467 1006- Fax (209) 467-1118 YJf, <br /> L1 15 1 c. <br /> ClientProject Manager <br /> , Tests Required <br /> Phone Number 1 <br /> Samplers (Signature) Invoice <br /> Project Name <br /> I` AGE 0 <br /> �%�� � �,✓ A10 Client ❑ <br /> Sample Location Solid Sample Type No of ,t <br /> Number Description Date Time Water Air Conts / �� Notes <br /> Comp drab <br /> 4->< <br /> )L <br /> a mq ed by ignature Received y (Signature) DatelTime <br /> Relinquished b ignature) Received by (Signature) .�� J DatelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) I / Date/Time <br /> Dispatched by (Signature) Date[Time Received for Laboratory by Date/Time <br /> Method of Shipment Laboratory Name <br /> special lnsltuctions I hereby authorize the performance of the above Indicated worts <br />