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} <br /> Cham-of Custody Number <br /> SECOR Chain-of Custody Record <br /> QAdditional documents are attached, and are a part of this Record <br /> Field Office <br /> �. <br /> Address ofAni f70 Job Name e1f��'�'r Z C.7 <br /> Location <br /> 6 G rl <br /> I <br /> i Analysis Request <br /> Project #�l T # — a <br /> Project Manager ° t 'Q <br /> 3 T m <br /> Laboratory C N <br /> C_ � C <br /> Turnaround Time <br /> r a �U U m S►� U <br /> 2�_ 7 <br /> C �U _C7 r ti <br /> i N1!O/1 w n a D ° <br /> Sampler's game— o �'° m� o i m �r <br /> M E � $' <br /> Sampler's Signature _ v N ° '�' <br /> p a„ ��n _T 0" <br /> Y r =o a `cv v c C G u, '�cv o y O (jo'TlrfkentS/ Z <br /> U a ao G � of ocv �c acv y ca c U <br /> Sam le ID Date I Time Matrix = �� ~0p � l Q� ''D _� �'�° ° � ~` �� Instructions <br /> _z g -0v 1z' u I I t <br /> lyroo <br /> LS <br /> li <br /> tz 00 I j tea <br /> r� } N f ' <br /> XI i <br /> �� S � I I �3r� tIL <br /> JD <br /> Specia Instructions/Comments Relinquish Recer y Sample Receipt <br /> Sig Sig _ Total no of containers <br /> P _- r A"f Print Chain of custody seals <br /> Company_ S15r�A Compan Rec'd in good condition/cold <br /> Time 3'N Date--?--/ 400 Time/D VE _ Dateoyos C3 Conforms to record <br /> Relinquished by _Daeved by Client <br /> Sign Sign <br /> Print Print Client Contact <br /> Compa Company <br /> T Date C Date Client Phone <br /> SECJP r,�STREG Reti 2AF � , I I <br /> l pate 1/ 00 Page—2- of <br />