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Advanced <br /> CH AfN F CUSTODPRECORO <br /> GeciEnvironmental, Inc pate 12- 1� e Page 1 Of <br /> 837 Shaw Road- Stockton, California-95215 - (209)487-1008 - Fax (209)487-1118 <br /> Client � ' Project Manager <br /> Tests Required <br /> Phone Number <br /> dr t coo <br /> -- S pfers (Signature) (I ) Invoice <br /> Project Name • G � � AGE <br /> Client ElSample Type ,C '^ <br /> Sample Location Date TimeWater Solid No of <br /> Comp Grab <br /> Number Description Air Conts Notes <br /> Qk5-13/�,Liqtr,4 <br /> �-kws- 1 1-21l Z- K <br /> e m uis e i nat 'Receivedy (Signature) DatetTrme <br /> 0 <br /> Relinquished by (Signature) Received by (Signature) �Z�� f {�`> <br /> DatolTrme <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Detertims <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Date(Time <br /> Method of Shipment Laboratory Name �u <br /> UYvt �ccll " <br /> Special Instructions 42e ` k 1 her authorize the performance of the above Indicated work <br />