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Cham of Custody Number <br /> SECOR Chain-of Custody Record <br /> Field Office 077 Sacramento D 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 03 Task# 0410 Analysis Request <br /> Project Manager Jaff Auchterlonie <br /> 0 <br /> Laboratory Kiff Analytical N4 <br /> cc 0 in <br /> Turnaround Time Standard T aT z yco <br /> LLA a <br /> CL 0m U (ii7 � OV m t <br /> Sampler's Name Tom Miller t @ Cb � "' �? m c3 <br /> H p O m UO �b (40 gO d � O <br /> Sampler' <br /> Signature m g 2 m N o N m <br /> o = _ = o _o E K a Comments) E <br /> Sample ID Date Time Matrix z i. F � a ¢ 8 > � z �, D in o LU Instructions z' <br /> MW-1 ( D It' Water X X 4 v, <br /> MW-1A ( 0)1s Water X X 4 02- <br /> MW-2 t 3 Water X X 4 03 <br /> MW-3 o Water X X 4 014 <br /> MW-4 $SS Water X X 4 (7� <br /> MW-4A Z Q.1-a Water X X 4 [ryC <br /> MW-5I t 1 o Water X X 4 (7� <br /> ,41 MW-5A /050 Water X X 4 0� <br /> MW-6 Or <br /> 6 (Of-(a Water X X 4 C)c <br /> MW-7 619 40 Water X X 4 <br /> Special Instructions/Comments Relinquished by Received by Sample Receipt <br /> 5 Oxygenates TAME, MtBE, EtBE,TBA, DIPE Sign Sign Total no of containers <br /> Global ID#70607700750(SIRC) Pant Print Chain of custody seals <br /> EDF Deliverables(email EDF to mkoch@secor com) Company -Saf Compa Recd in good condition/cold <br /> email lab report to dherzog@secor com Time �-Date 3fl Ti Date Conforms to record <br /> Relinquished by Received b} <br /> Sign Sign Client SECOR <br /> PrintPrint r_-f- Client Contact Baan Carey <br /> Compa Company Client Phone (916)861-0400 <br /> T Date Time X03 at p ext 2417 <br /> SECOR CUSTREC Rev <br /> Date C 2 4Page <br />