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1 _ <br /> Chain-of Custody Number 5 <br /> 4 <br /> SECOR Chain-of Custody Record <br /> Additional documents are attached, and are a part of this Record <br /> Field Office su o 0 Job Name 2 <br /> Address - <br /> I V Location So S V) , C <br /> 0 <br /> k# Analysis Requsst <br /> Project# � ' D 1 .� <br /> Project Manager A a O✓ — I I f <br /> Laboratory-& <br /> d C I � <br /> Turnaround Time_ _ ; M 2 ry LXU C <br /> v o c ¢ r-ta 7 pr U I U <br /> v•'rLU S <br /> Sampler's Name m o 00 a o n m I <br /> Sampler's Signature _ _ - 9 N ¢ 'N °o J T y >ti <br /> c ec iV <br /> a o n�i R o N w o o ° U Comments/ <br /> Sample!D Date ' Time Matrix = m �' �- Q � n i° c`° `^ a' Instructions Z <br /> 01 <br /> z <br /> 03 ! <br /> b E <br /> Ll ' <br /> Special InstrUctlons/CO ments Relinquish y Receiv Sample Receipt <br /> Ioor 1 Sig Sign Total no of containers <br /> GL j�f N ��1 I�� r��LC9 t,7 Print I ¢�� - Prm �� r Cham of custody seals <br /> Company St_�;6Q Company Recd in good condition/cold <br /> Time '.7e, Date 9' -00 Time bat Conforms to record <br /> Relinquished by Received by lClient <br /> Sign Sign <br /> Print Pnnt Client Contact <br /> Comp Compan <br /> Ti Date Ti Date Client Phone <br /> S'_�OP!'VSTPEC Ary 2R4 *.{ 1 1 � h q <br /> r <br /> Date II r _r V Page_L of 3L <br />