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Cham of Custody Number <br /> SECOR Chain-of Custody Record <br /> Field Office 077 Sacramento Additional documents are attached, and are part of this Record <br /> Address 3017 Kilgore Road, Suite 100 Job Name 7-Eleven Store#19976 <br /> Rancho Cordova, CA Location 1399 North Main Street <br /> Manteca, CA <br /> Project# 77EL.19976.04 Task# 0410 Analysis Request <br /> Project Manager Jaff Auchterlonle <br /> Laboratory Kiff Analytical <br /> ca V (4 W <br /> Turnaround Time Standard <br /> N <br /> Q a c 'o m <br /> W aIDU n <br /> c o— .0m 80 � Oe6 r, m m c <br /> Sampler's Name ��,,,, cc <br /> z N O .._ 0 <br /> Sampler's Signature 12 `" E _ `° ` o 0 <br /> Q ao � o in n mo icy„ iia c o � U a o <br /> a t „y Eco aw amp ..l. ap � m <br /> x s = o a 5 v $'� e � si'a � ,� o o m Comments/ <br /> V a QO d O O N t9O Q1NOa m N N N Q rz <br /> Sample ID Date Time Matrix z I m � m = rb w � �, r w Instructions z <br /> MWA 12')D of N Y 5 Water x X <br /> X X X X 3 <br /> MW-1A I 11KWater x X X ly X X 3 <br /> MW-2 r 5'to Water x X X X X 3 <br /> MW-3 N y5 Water x X X X X 3 <br /> MW-4 ILiS Water x X XX X 3 <br /> MW-4A 1Z SA Water x X X X X 3 <br /> MW_5 !Yio Water x X X X X 3 <br /> MW-0A 13 Ya Water x X X X X X 3 <br /> MW-6 /e7 Water x X X K X X 3 <br /> MW-7 o Water x X <br /> X `� X X 3 <br /> Special Instructions/Comments RelinquishefiFpy Received by Sample Receipt <br /> 5 Oxygenates,TAME, MtBE, EtBE,TBA, DIPE Sign I A Sign Total no of containers <br /> Global ID#70607700750(SIRC) Print Print Chain of custody seals <br /> email EDD to dacatl,n c@i secor com Company �rr,r Company Rec'd in good condition/cold <br /> email lab report to dherzog@secor.com and Time Date_1L-1 p_a y Time Date Conforms to record <br /> tmiller@secor com Relinquished by Received by <br /> Sign Sign Client SECOR <br /> Pnnt Print Client Contact Tom Miller <br /> Company Company Client Phone 916 861-0400 <br /> Time Date Time Date ext 279 <br /> SECOR CUSTREC Rev 2198 <br />� Date <br /> - o -Dy Page ///f <br />