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I, l• mm M IMI � � r� ■� �■ �■ I� � I• � . <br /> CHAIN OF CUSTO&ECORD <br /> j Advanced 3 <br /> �" Pa <br /> GeciEnvixonmental, Inc. Date ge of <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> Project Manager <br /> Client � � 'w � Tests Required <br /> Phone-Number <br /> 0 <br /> Samplers: (Signature) <br /> Invoice: <br /> s /L '� <br /> Project Name AGE <br /> Client ❑ <br /> Sample Location No. of Notes <br /> Number Description Date Time Sample Type Solid Water Air Conts. <br /> Comp. Grab. <br /> i <br /> e inqurs y: (Signature) acarus y: ignature _ <br /> DatelTime <br /> ..._. <br /> Re inquished by: (Signature) Received by: (Signature Date/Time <br /> N/p, P[IESEAVATION <br /> Relin uished b (Signature) ceivad borator tot 'aid analysis: (Signature) Date�Time <br /> � Y' ) CO�1[llTjO�V If31 Y Y <br /> CONTAINEBS <br /> Dispatched by: (Signature) Datel7ime a iveQ y: DatelTime <br /> or t aboral ry <br /> lV �'LA <br /> Method of Shi me Labora ory Name <br /> YLI <br /> I'W vm <br /> Special Instructions: I hereby authorize the performance of the above Indicated work. <br /> ' VAJ/ <br /> I. <br />