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• • Chain-of Custody Number <br /> SECOR Chain-of Custody Record <br /> Field Office <br /> Additional documents are attached and are a part of this Record <br /> -- s��Jr`------------ -- —F�— <br /> L aJ� S u1 �Xv J Job Name T��d�MMy — — - <br /> Address 1 <br /> Location [ t✓tG� r �.J,4 <br /> Project ## <br /> 000o)-Oct 01 Task #f (�V+CO` Analysis Request <br /> Project Manager UIV) 130,A i� <br /> Laboratory - M <br /> Turnaround Time_ _' 2"rv m y � <br /> vcU <br /> z 6 m na (D ` 15 G <br /> a. <br /> v°° <br /> U.] m o in am <br /> Sampler's Name co 0 0a <br /> CO E N N �p °7 C�1 W T` V=nts/ <br /> E <br /> IL <br /> Sampler's Signature D i� Y^ z p a 5 o� E;n W 0 cu N o t � z <br /> o �, o a v Instructions <br /> Sample ID Date Time Matrix X Fa-W a co F' ¢c4 `� _(Oa` r <br /> 9/.z= Io i X --- - -- - -- <br /> WOO <br /> Sample Receipt <br /> Special Instructions/Comments Relinquished by <br /> $1=Co ` Received <br /> Sign Js. �!+� ..— Sign Total no of containers <br /> E 21 <br /> Print G Print Cham of custody seals <br /> Company Ffo Company d Recd in good condition/cold <br /> Time OO Date �S Time ��_Date Conforms to record <br /> Relinquished by Received by Client Seto <br /> Sign Sign Sohn Qat" <br /> Print Print Client Contact <br /> Company Company 7 r 37�- 336 <br /> Time Date Time Date +++ Client Phone <br /> (t <br /> CUSTREC Rev 1195 <br /> Date 1Z.5 7 Page_L_of <br />