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I <br /> *Advanced CHAIN OF CUSTOD CORD <br /> Date rr 2 Page of <br /> GeciEnvironmental, Inc <br /> 4005 North Wilson Way Stockton,Cahlornia-95205 (209)467-1006-Fax(209)467 1118 <br /> Client e- Project Manager <br /> Tests Required <br /> Phone Number <br /> /Isay& <br /> Samplers (Signature) Invoice <br /> Protect Name wdtt-w AGE p/rr /i � Client p <br /> w <br /> Sample Location SolidSample Type No of Notes <br /> Number Description Date Time Water Air Conts <br /> Comp Grab <br /> -Relinquished b�y (Signature ece ve y rgnat a QatelTime <br /> Relinquished by (Signature) Received b nature) DatelTime <br /> Relinquished by (Srgnalure) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory by DatelTime <br /> Method of Shrpm 1 1 Laborat ry e <br /> 1 <br /> Special Instructions I hereby authorize tilhe perfor ante of the above indicated work <br /> �GEI PRESr RVlITfR1 w <br /> I A 'F7, r'rslfE <br /> HEAD SMCE ABSLNGe Coi�ftim'll'7S. <br />