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r - <br /> Chain of Custody Number <br /> SECQR Chain-of Custody Record <br /> Feld Office 077 Sacramento [3 Additional documents are attached,and are part of this Record <br /> Address 3017 Kilgore Road,Suite 100 Job Name 7-Eleven Store#20632 <br /> Rancho Cordova,CA Location 4627 Da Vinci Onve <br /> Stockton,California <br /> Project# 77EL..20632.43 Task# 0410 Analysis Request <br /> Project Manager Jaff Auchterionis <br /> Laboratory Kiff Anatytical W m g <br /> Turnaround Time StandardQ LX <br /> d s A N <br /> Sampler's Name Danielle Catiln-Wrl ht W � o _ 03 <br /> _ <br /> m +� <br /> Sampler's Signature r L m R 3L 9F o <br /> ab� - gx <br /> E <br /> Sample ID Date a Comments/Time Matrix > a <br /> Instructions z' <br /> 12 4 L 11 04!04103 19;1/L Soil X I X 1 i <br /> L Z <br /> Special Instructions/Comments Relinquished by Received by Sample Receipt <br /> S oxygenates TAME,MtBE,EtBE,TBA,&DIPE Sign ign Total no of containers <br /> emall results to jauchterionleesecor.com Pnntnot Chain of custody seals <br /> Cony J Company Recd in good condition/cold <br /> Time Date y Time Date Conforms to record <br /> Relinquished by ecei by' <br /> Sign Sign Client SECOR <br /> Print Print o lA �� Client Contact Jaff Auch0lonie <br /> Compa Company t 1 nt Phone (916)851-0430 <br /> Date Time �,OSp Date 0'1Q ext,241 -''— <br /> sEooa«usrnEc n,�, ITA <br /> Date 01' 0403 Page 0 r <br />