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I <br /> Chain of Custody Number �� q 7 • <br /> SECQR Chain-of Custody Record <br /> Field Office 077 Sacramento Q Additional documents are attached,and are part of this Record <br /> Address 3017 Kilgc re 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 alysis Request <br /> Project Manager .teff Auchterionle <br /> Laboratory WIT Analytical m <br /> Tumaround Time Standard W = o ,y <br /> Sampler's Name Pt" r 1;o a s <br /> Sampler's Signature < s 3 N10 c s Comments/ <br /> Sample ID DateTime Mata Q <br /> Instructions z <br /> MW1 IZ.10 a 1LfY:*' Water x X X X XIX 3 0f <br /> MW-1A / Water x X X X X 3 02 <br /> MW-2 r 6'ro Water x X X XX X 3 03 <br /> MW-3 r+y5 Water x X X X X 3 09 <br /> MWS Lrs Water x X X X X 3 05 <br /> w MW-4A <br /> 1;Sa Water x X X X X 3 06 <br /> MW-6 I Yra Water x X XX X 3 O7 <br /> MW-SA 13* Water x X X X X X 3 09 <br /> - <br /> NW-6 o * Water x X X K X X 3 01 <br /> MW-7 o Water x X X X X 3 110 <br /> Special Instructions/Comments Relinquishe y Received by Sample Receipt <br /> 5 Oxygenates:TAME,MtBE,ELBE,TBA,DIPS Sign U 0 Sign Total no of containers <br /> Global ID#T0607700750(SIRC) Pnnt Print Chain of custody seals <br /> email EDD to dacatlin@secor.com Company a,r Com Recd in good conditionloold <br /> f <br /> ail!ab report to dherzog@secor.com and Time Date_L_ p_e y T Date Conforms to record <br /> liler@secor cam Relinquished by Received br <br /> Sign Sign Client SECOR <br /> Print Print Client Contact Tom Miller <br /> C_o� y Company ;fC A„ Client Phone 916 96144 <br /> Yt�rie Date Time k1�Date ext 279 <br /> E16COR CUMEc rev ZU <br /> Date rL-A0, -oY Page / <br /> i <br />