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- Advanced CHAIN OF CUSTODY RECORD <br /> - Date _ _� Page of <br /> GeciEnvironmental, Inc. <br /> — 837 Shaw Road-Stockton,California-95215-(209)467-1006- Fax(209)467-1118 <br /> Client Ka,A W ch c r Co-r W o-bX Project Manager Tests Required <br /> T m G;"-e'l ! &r- <br /> Phone <br /> irPhone Number <br /> Sam p ers Signature) Q. �.� � Invoice <br /> Project Namenn L ` � AGE L- <br /> K.a, w c -Cr Client ❑ <br /> Sample Location Date Time Sarrip6type, Solid No of q.Z '� j <br /> _ Number Description Water Air Conts Nates <br /> Comp arab <br /> !t liol <br /> ,iw►w 1Z� 11 1► 2 15 � / <br /> Roil is y (Signature) ece ve y gnature) DatelTiime <br /> 11-11-©]/ OW <br /> nquished by (Signature) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatelTlme <br /> Dispatched by (Signature) Date/Time afor 4oratory Date/Time <br /> (e,r- 0 '�n'1 <br /> Method of Shipmentr Laborato Name <br /> Ca tf Over r ,- >'-t CJG's� �e- <br /> Special Instructions 1 hereby authorize the performance of the above indicated work <br />