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I i <br /> Chain-of Custody Number <br /> SECORI1 Chain-of Custody Record 1517- <br /> S <br /> Field Office cot _1 _ 11 _ <br /> _ [DAdditional documents are attached, and are a part of this Record <br /> Address 310 Olt)V o tcc !I _ Job Name T�Xac <br /> Onc-1 C67 If Y_5J Y Location 4`"0 6r w - <br /> !I IIK LA <br /> Project# Nopol -00 -oZ. Task# !i <br /> II Analysis Request <br /> Project Manager 30111 w6i" <br /> Laboratory 3 C =N co .. y 8 <br /> d <br /> Turnaround Time l�Tfl+'► r O a 2 a Y <br /> L m �U U 5 to CU <br /> C o c,C7 m m{7 a o <br /> Sampler's Name '" r� o 0 o 00 m o a y o `m <br /> � E E �m am co <br /> olaoo ��11, �� <br /> Samplers Signature a ,�, �, E U <br /> v a� do z aN wo oa n z U Comments! z <br /> -Sample-113 Date Time Matrix z �-co F-w d$ a�n z$ cn to a 0 F-r- a-� r Instructions <br /> )oj S )219,0 <br /> jG�� tots i z:3a �r x 1l II � <br /> ' II II <br /> 11 If <br /> �I II <br /> 11 I! <br /> II II <br /> II II <br /> �I II <br /> Special Instructions/Comments Relinquished by Saok2 Received byt Sample Receipt <br /> Sign Sign Total no of containers Z <br /> Print G'' RY��R_ C N,PT — Print Chain of custody seals <br /> CompanyI g kro t Company P0, VV I I Recd in good condition/cold <br /> Time :3 11 Date Time Date Conforms to record <br /> Rellnqulsi d ° Receiv by <br /> Sign Sig Client -SrCo� <br /> Print ! " Print( <br /> Client Contact ­RDD &'a+�`n <br /> Company �_d C=.__ _ Company <br /> Time /V 16 Date �D Time 68.60 . Date Client Phone koly-s6"`m <br /> fl II <br /> SECOR CUSTREG Rev 1195 <br /> ' t � 13 Z '76 <br /> Date Pageof.� <br />