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Chain-of Custody Number <br /> SECOR Chain-of Custody Record <br /> C <br /> Field Office ix Additional documents are attached, and are a part of this Record <br /> T� �, � <br /> Address O hY`'-- c v - �2 4 .lob Name <br /> Location _ t � H 10 Z374 k <br /> Project # 50 3 `0U ~-D Z Task# Analysts Request <br /> Project Manager 6Pd' L72LV – r U� r <br /> r y <br /> Laboratory C <br /> ki <br /> Turnaround Time t 4r o z N in CZ tin <br /> 7 <br /> Sampler's Name a o E co U N O Q o 0 o Cq p m 0 �°^� �- <br /> Sampler's SlgnatUr O_ In �n v E�' �0 0 7 m `-'° R a Comments/ <br /> 2� r E rjer Eln in co acv o" J <br /> U O 0.o 0. 0 ocv �b acv ago pc c d U z <br /> Sample IQ <br /> Date Time Matrix z m 1- <br /> 58 -11, <br /> - > z -� Instructions <br /> 5 8 --/✓ i l z.�-96 's w4�t� <br /> 513 --3 ►� 3 i x -Rd �,'oo / S <br /> 5 a- y ✓ 2qS__ <br /> -513 - 7- Ilio s` <br /> .513 <br /> .513-1 0 1 1 L _-7u <br /> Special Instructions/Comments Relinquish by Received by Sample Receipt <br /> /,, Sig Sign Total no of containers <br /> 2 Yc /7, Print Print Z Chain of custody seals <br /> CompanyO Company Rec'd in good condition/cold <br /> i�l se initial• -' Time r Date Time Date/,,,,,.— Conforms to record <br /> Samples Stored in ice I Relinquished by I <br /> ve y <br /> Appropriate con;aine ��.�,. Sign Sign <br /> lcI <br /> Client <br /> nles r-eserved Print Print Client Contact <br /> '! 's I'll }tns:t Etzadspoce Compo Company <br /> Co ,merz" Time Date Time �1`SG Date lt_zt0114 Cltent Phone <br /> I TREC Re+ 1195 / <br /> t <br /> R Date —L_ / 26 1 p Page l of <br />