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Advanced CHAIN OF CUSTOD RECORD <br /> - Datepage ' — of <br /> - GeciEnvironmental, Inc <br /> 837 Shaw Road - Stockton, California- 95215 (209) 467 1006 Fax (209) 467-1118 <br /> Client �' � ` Project Manager Tests Required <br /> P one Num r <br /> Invoice <br /> Samplers (Signature)f <br /> i� l '�-- AGE ' <br /> Protect Name 2� °c Client ❑ <br /> Sample Type % <br /> Sample LocationNo of Notes <br /> Number Description Date Time Water Air Solid Conts <br /> Comp Grab <br /> Ak L( X" -1K <br /> w A <br /> �t .J <br /> PW 20 <br /> W - <br /> &Retmquish4 <br /> is e ( i n re) ecetve y ignature DatelTime <br /> cj3�'�_ �(, 31) <br /> by (Signature) Received by (Signature) Date(Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) 0ate(Time <br /> Dispatched by (Signature) date/Time Racervv fqg,Laboratory byPate/Time <br /> Method of Shipment , V abore tory Name — <br /> Special Instructions I hereby authorize the performance of the above lndmided work <br />