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CHAIN OF CUSTOP RECORD <br /> Advanced Date , Page � ofGeciEnvironmental, Inc <br /> 837 Shaw Road - Stockton, California- 95215 - (209)467-1006 Fax (209) 467-1118 <br /> Client , y c- Project Manag�er�` '�5 Tests Required <br /> P ne Number f <br /> Samplers (Signature) Invoice <br /> / AGE <br /> / / ❑ <br /> Protect Name Client,', � r _ � � / <br /> Sample Type Solid No of j <br /> SampleLocationpate Time Water Notes <br /> Number Description cam Grab Air Conts <br /> P <br /> tic <br /> w - <br /> onte/Time <br /> i uis e y eceive y ignature ��/, � <br /> rte <br /> r DateJTime <br /> ROnquished by (Signatur Received by (Signature) <br /> pate(Time <br /> Relinquished by (Signature) Reserved by Mobile Laboratory for field analysis (Signature) 1 �~ <br /> .s <br /> L}atelrime Be $ ratory by Date ime <br /> Dispatched by (Signature) �/ /3(� 0?//— <br /> Labor to N J +'� _R <br /> Method of Shipment �rs�� s ��J�` <br /> i h xeby authorize the periotmance of the above Indicated work <br /> Speclat instructions <br /> `� = CV1 <br />