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1 <br /> Chain-of Custody Number <br /> SECOR Chain-of Custody Record <br /> U Additional documents are attached, and are a part of this Record <br /> Field Office � ° <br /> < O v Job Name 6�'V v ra ry 1?2 a <br /> Address 3 <br /> Location �$ , C l <br /> Analysis Request <br /> Protect # Ta k # <br /> Protect Manager ° <br /> Laboratory—t7p -- I 64N m <br /> �� mEO <br /> ti <br /> Turnaround Time - U) ro 2 <br /> x <br /> a^ a 02 >° � m � <br /> { ro 3 y <br /> Sampler's Name_ r o a o p o m a m o v o M c Z m <br /> �E "o mN �o >C" <br /> Sampler's Signature E - U _ a <br /> o n x ' r a °,1 ;- F" a m ?a �-' J o Comments/ z <br /> U ar Qc n. as ON �aT mcg mo <br /> Sam le ID Date { Time I Matrix x a x �' d cO a K- Instructions <br /> Z <br /> _ f <br /> 4 I <br /> I <br /> Special Instructions/Comments Relinquish Receii y �^ Sample Receipt <br /> Sig g Total no of containers <br /> Print Pnn �� � '`� <br /> Chain of custody seals <br /> Company1 Compan ' h_ Ree'd in good condition/cold <br /> Time 3° Date_�� I Time/� Dat Conforms to retard <br /> Relinquished by Received by <br /> Sign Sign <br /> Print Print Client Contact <br /> Compo Compan <br /> TI Date Tim Date Client Phone <br /> SECOP.rUS7REC Rev 2+93 q Q <br /> Date r Page ,-7 of <br /> J J <br />