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iliiitiitt� iii � � t� � � t� � � � 1• � � � � � <br /> l <br /> Advanced CHAIN OF CUSTOD RECORD <br /> GeciEnylronmental, Inc. Date II-IU-00 Page of <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> "J, Project M ager <br /> Client � � 1� �, j 1 L. � �� Tests Required <br /> Phone Number <br /> Samplers (Signature) 6 , Invoice <br /> Project Name <br /> AGE LSI, <br /> J , <br /> Te-L, fe r n, �� ,�\ Client ❑ <br /> Sample Location Sample T e No of <br /> Date Time Water Solid Q a Notes <br /> Number Description Air Cants <br /> Comp Grab t� <br /> mv"V IUCAD W -,� ��-�U- a`lt'o 11l -�� 4 <br /> f <br /> ehnauifAtad y { ign ) i <br /> i nature p Date/Time <br /> Relinquished b (Signature) (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date rime <br /> Dispatched by (Signature) Dale/Time Received for Laboratory by DaterTime <br /> Method of Shipment ` ��� Laboratory Name <br /> U tUX- w <br /> Special instructions I hereby authorize the performance of As above rndicated work <br />