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C �5� Chain-of Custody Number <br /> SECOR Chain-of Custody Record <br /> Field Office <br /> S , C o Additional documents are attached, and &e apart of this Record <br /> Address 340 1Nt`J O A�.3 IZo Sup 310 Job Name _TeX a( D <br /> or S zo Location <br /> I s�oc kin e�- <br /> Project # N0001-00L -0 Task# 0001- Analysis Request <br /> Project Manager 'PhA <br /> Laboratory Vol L N co <br /> Turnaround Time 0.m a oC? 06 y L / �/ o <br /> C11' <br /> ar = o �� a m� a ? o <br /> a - <br /> Sam <br /> Sampler's Name C PAe C11 Pr fw o o opo ca o 0 o o m a M m 16L:Yp E E c� c.- nw m _�(iiT mN Q USampler's Signature v = o a CO <br /> o N N Comsl Z <br /> Sample ID Date Time Matrix i m H m <w o z w cn 0 r- a` InstrnctEons <br /> TN 5/11 11W Atr <br /> I� sh,- 1100 �}f`r <br /> Special Instructions/Comments Relinquished b Meg>X Receive by Sample Receipt <br /> Sign Sign Total no of containers <br /> Print ARV V_. CliflPrint C&M I Chain of custody seals <br /> Company Sge" Company Recd in good condition/cold <br /> Time /0 Date S 7 Time (U� —Date -J Conforms to record <br /> Relinquished by Received by 5 Client 1?CcYC <br /> Sign Sign <br /> Print Print Client Contact 1-00fl <br /> Company Company <br /> Time Date Time Date Client Phone4/o6 b-%0 ' <br /> 5ECOR CUST REG Rev 1795 <br /> Date 113-127 Page I of J_ <br />