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ter■...■ � � � �� � �� �� �� � i, � � ttti � 1• � i• <br /> Chain-of Custody Numtrer <br /> SECOR. Chain-of Custody Record <br /> xAdditional documents are attached, and are a part of this Record <br /> Field Office ,5A <br /> Address O A ° �r%Z d 210 Job Name <br /> /i % 1 D Location <br /> Project# SV/73.0ol_p 2 Task# Analysis Request <br /> Project Manager&zz; .,44 w 2ai» <br /> tr y <br /> Laboratory r• cs o C0 8 � � <br /> Turnaround Time f `- o d N � �,� c <br /> O0 m w N U <br /> Sampler's Name m U o 020 o .50 '06 o M 2 r w <br /> CD <br /> a <br /> Sampler's Signatur p ,n =,� = E aao m rnm m �_w w o a mss, E <br /> U a n o n °o aai �o mN �'o o� �' U e Comments) z' <br /> Sample ID Date Time Matrix s Co.1--co a CD c0 x(0 U) N a Instructions <br /> 1-23-W KOZO � <br /> 50-3 1-24-16 f;Oo S <br /> -S S <br /> N:YD S <br /> w14 W30 <br /> SI3� 9 s <br /> Special Instructions/Comments Relinquisho by Received by Sample Receipt <br /> LI �r Sig Sign Total no of containers <br /> 1 Printer Print Chain of custody seals <br /> Company ESE O Company Rec'd in good condition/cold <br /> Time / r Date Time Date Conforms to record <br /> Relinquished by Receive by <br /> Sign Sign 's�.� r Client <br /> Print X., Print <br /> Client Contact <br /> Compal) Company..��,. Fy�1 trR_ <br /> h Time Date Time `� 5� Date 117-611114 Client Phone <br /> IkEW <br /> R C EC Rev 1185 11 // <br /> Date ._I - 1- �6.1 t9�_ Page_.L of <br />