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l <br /> Advanced CHAIN OF CUSTODY RECORD <br /> �._��C,5 ZGeciEnvircinmental, Inc. Date Page12) <br /> 837 Shaw Road- Stockton,California•95215-(209)487-1008•Fax(209)467.1116 O� 0-5'1 <br /> ClientPrgect =ager <br /> Rtsku�aiv�•+ �isL��c�<^;.`t b�,+ Tests Required <br /> Phone Number <br /> 11$4 *7-1 "k <br /> Samplers: (Signature) Invoice: <br /> Gly � AGE <br /> Project Name �5;L r�� C V_ .1/a'� � Client ❑ <br /> ample Type A <br /> Sample Location Date Time Water Solid No.of Notes <br /> Number Description comp Grab. Air Conts. <br /> 13-1tc W ( e(�Q( cw, {3 i 1. d-0 jC3t: >► i II <br /> '0 S to% `A <br /> �5-i-1 -tv tDt ilea k l )� <br /> S h " 151 1110 <br /> B-1"i WR �Yoly B—t 137 x 5 <br /> o m we e Y rgnalure <br /> Received y: gnalure Date[D <br /> 1 <br /> Relinqu' d by: (5fgnature) Received by:(Signature) Da[ ime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) DatelTime <br /> Dispatched by: (Signature) aternme v rao Oab/rimp _ <br /> Method of Shipment: (. Laboratory Name /' <br /> l�'lrtt t_ TECA <br /> Special instructions: I hereby authorize the performance of the above indicated work. <br />