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Advanced CHAIN OF CUSTOD�RECORD <br /> � <br /> GeciEnvironmental, Inc. Date Page t ` <br /> 837 Shaw Road-Stockton,California-95215- (209)467-1006- Fax (209) 467-1118 <br /> Client _z Project Manager Tests Required <br /> e - <br /> Phone Number <br /> Samplers (Signature) 1= Invoice <br /> v a ' ,5ti AGE E]Protect Marne Client ❑ <br /> d w vA <br /> Sample Location Sample Type No of �"'� ,�;�° ,_;� ,��� <br /> Number Description <br /> Date Time Comp Grab Air Solid Conts Notes <br /> " r <br /> i <br /> -e <br /> !c <br /> e t w F r r <br /> n <br /> ( egnature eeerve yrgnature Datelreme <br /> ti r j <br /> Relinquish ad by (Signature) Received by (Signature) t Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Despatched by (Signature) DatelTima Received for Laboratory by Date/Time <br /> Method of Shipment Laboratory Name <br /> Special Instructions E I hereby authorize the performance of the above Indicated work + <br /> t � ; <br />