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Chain-of Custody Number <br /> SECOR Chain-of Custody Record <br /> Field Office %Additional documents are attached, and are a part of this Record <br /> Address r _574,116, <br /> �2, Job Name <br /> — Location A-/117 gyp <br /> Protect # - `d Task # Analysis Request <br /> Protect Manager T_-eX.1 g Alb 4174 T r y <br /> Laboratory s 0 c or W <br /> CL <br /> Turnaround Time 1- a co z <n � ro n <br /> c <br /> O( m r <br /> X m z a 7CUV7 y �'0 a m �+ o <br /> Samplers Name �' H m U N O Q o o^I p 4°^ _ a <br /> [00 _N Q-)0 ?N 0 J N <br /> Sampler'sSignature - o o cv o`n E us ro N o=° -1.1 Comments! <br /> Sam le ID Date Time Matrix T c m ¢SO � z(0 N w a n N a`. �0_ 'v Instructions <br /> S' - I Z I-ZY16 I r'00 j <br /> 8- 13 i-Zy�._% 141av 1 <br /> S 13- f S is- i-Z5`16 5=;0 _ 15- 4, <br /> 16 1-ZS t j �- <br /> lh1 - t 26- 6 1!00 X I I I f 13 j <br /> Special Instructions/Comments Relinquishpd by Received by Sample Receipt <br /> Stg Sign Total no of containers <br /> Print Wi Print Chain of custody seals <br /> Company Co ny Reed in good condition/cold <br /> Time — Date ime D Conforms to record <br /> Relinquished by R6ceived by - <br /> Sign sign Client <br /> Print Print e`"'' Client Contact <br /> C any Company <br /> ime Date Time '� S Date c =6 Client Phone <br /> SECOR CUSTREC Rev 1/95 _- Z6 1 �f <br /> Date �i Page �- of <br />