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Advanced CHAIN OF CUSTODY RECORD <br /> GeciEnvironmental, Inc. Date 3 - -03 Page of_. <br /> 837 Shaw Road- Stockton, California- 95215-(209)487-1008- Fax (209) 487-1118 4 7 — <br /> Client <br /> ,Client .�[ Project Manager Tests Required <br /> 1 �fl Q.Y <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> Project Name <br /> AGE <br /> �( 16, Client ❑ <br /> Sample Location Sample Type <br /> Date Time Water Solid No of Notes <br /> Number DescriptionDate <br /> arab Air Conts <br /> SON Iatt iM%A' — ) <br /> U.) - r' <br /> I as- <br /> e i quis e i ature Received y gnakure Date/Time <br /> Yn <br /> Refcnquished by (Signature) Received b S� +� <br /> y (Signature)) Detalrima <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Aecaived#or aboratory by'� Date/Time <br /> `J �0 <br /> Method of Shipment Labo ry Na e <br /> ADV i �� C CL C <br /> Special Instructions I hereby authorize the performance of the above indicated work <br />