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WN <br /> Advanced CHAIN OF CUSTO Y RECORD <br /> GeciEnvironmental, Inc Date �� IPa�e -2 of <br /> 4405 North Wilson Way-Stockton,California 95205 (209)467 1006-Fax(209)467-1118 <br /> -Pnc <br /> Client I Protect Manager <br /> �G l <br /> T t M C S L I'V Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> Protect Name PSG ( I C / �� AGED <br /> S \ Client ❑ <br /> Sample Type <br /> Sample Location <br /> Number Description Date Time Water Solid No of �, �v�� Notes <br /> Comp Grab Air Conts <br /> ( I L6 <br /> V—W ,l q-15- Z i ao X <br /> Relin u� hied b (Si ature eceived by (Signature) Date e <br /> 3 60r <br /> Relinquished by (Signature) Received by (Signature) DatelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Receive for Laboro b Date/Time <br /> (do t U 3� <br /> Method of Shipment Laborato y Name <br /> Co OJ Z P'>4"t_�Irt � c tr u7 I r� <br /> Special Instructions I hereby authorize the rtormance of the above indicated work <br /> v� I ! <br />