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N <br /> 0 Chain-of Custody Number <br /> SECOR Chain-of Custody Record <br /> �� UAdditional documents are attached, and are a part of this Record <br /> Field Office <br /> Address - WO w i l lu-1 FAA &0 Job Name �o <br /> � a i �- C1�� w Ay(�}C Uf � �(�-- Location S X - <br /> t <br /> Project # Nopo1-00��v � Task # <br /> Analysis Request <br /> Project Manager JDkA t32w�' r <br /> Laboratory VoL a ° -� 1-- C <br /> Turnaround Time S MIra o <br /> ro �� <br /> 06 In <br /> Sampler's Name L7Ae e,i E U a 00 c m O ani o m d° o <br /> Sampler's Signature n � �, °1C CD W - ( I � <br /> =r 2r = oa My or E,n Vi as :ncv o•" -J Comments/ <br /> U 8.o ao aL �o ocli �o wc� mo o� c °} U Z <br /> Sample ID Dale Time Matrix r i-co �m �- ¢( CD _(D CO(0 0_40 n a-2 Instructions <br /> Obt <br /> Special Instructions/Comments Relinquished by Sr Cb�C Rece� y t?C Sample Receipt <br /> Sign Sign Total no of containers <br /> PrintGAe L It "T Print Chain of custody seals <br /> Company lu Company UoC Recd in good condition/cold <br /> Time 5`� Date -lol Time 5`1-5 Date�7 Conforms to record <br /> Relin ed - Received by � � <br /> Sign t tc, Sign Client <br /> Print ti 4 Print Client Contact lbna �,V"'Q <br /> Company l/C-` I Company <br /> ti Time �2 Date ( Time Date Client Phone,�rf0� <br /> SCGOR GUSTREC Rev V95 <br /> Date � 1 f� 1 �7_ Page—Lot �_ <br />