Laserfiche WebLink
� I <br /> i <br /> Chain-of Custody Number <br /> n µ <br /> SEOQk Chain-of Custody Record <br /> Field Office <br /> [f Additional documents are attached, and are a part of this Record <br /> s � � � <br /> Address Ao W i'd o-v Ogg5 KIS` II Job Name XU _..._. ._ <br /> C ori Co 5z-� II II Location �d w�s�- ecu`-�r' <br /> II I[ 5-hc k e <br /> Project # NaQ1 - 00�--C>7- Task # lnA 09 <br /> II I[ Analysts Request <br /> Project Manager w <br /> Laboratory Q C rZ'ndl �,Q t0 G'q (2)0 7 S5� <br /> Turnaround Time S r1 0- a @ rn� y C <br /> O_ _ C ,fI <br /> Sampler's Name �`' lt` �� �$ m �o 00 Mo 20 yo mt:� 1� <br /> C.- r, l <br /> Sampler's Signature o ,E & 0 o 2 gN� 0 0 �� u dao � �N � 1� � <br /> X`T' =t2 = o m� F� E? vai e3 N oro � Comments/ <br /> U 0_p -1 d �O ON wN No OC C (D U z <br /> Sample ID Date Time Matrix x ►-w 1, co l- a CD w x v�10 a w n a Instructions <br /> r <br /> -71310 I:o_� PH r <br /> 713 <br /> II I[ <br /> II II <br /> - <br /> �, <br /> II �I <br /> II 1I <br /> Special Instructions/Comments Relinquished by b Sample Receipt <br /> Sign II i _J a C —� Sign Total no of containers <br /> AZ <br /> Print ��C� 0IN--i- _ Print f � Chain of custody seals <br /> Company 11 :Sac of_ Company D4= Recd in good condition/cold <br /> Time Date Time Date Conforms to record <br /> R , uis iI[ b afcr <br /> Sign It y Si Client " <br /> Print u 1 Print ACL 071 raQ� �,, <br /> Company ti Company Client Contact Qro <br /> Time! 11 Date Time C$C:'O Dates - Client Phone `5 3 <br /> If <br /> SECOR CUSTREC Rev Md <br /> Date 7 1 -3 1 �6 Pa 01 4—' <br />