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� i • <br /> Chain-of Custody Number <br /> SECOR Chain-of Custody Record <br /> Field Office � � y Additional documents are attached, and are a part of this Record <br /> Address S O v E 1 Job Name ?l M OF-0 v'd, <br /> S Ac-e `�S>3 Z Location 114 WO L H�j Li <br /> Project # Loao 5 - �-'o 1 ^O t Task # LoC.o- Analysis Request <br /> Project Manager Jo Y1 N om„:'e v- � <br /> i <br /> Laboratory e:xLc i._ 0 <br /> CJ SU U C <br /> Turnaround Time 51+� P�0 a m N cn mcn <br /> o C] o d 00 CO o <br /> �� � o mU � mO d � cNo 0 <br /> Sampler's Name �---Y,Y k �^ w a - <br /> p � o O oo U0 OQ mo t°o �o �r m <br /> Sampler's Signature t{--J rl� a,E m W �� ° m y a E <br /> p g ° z� z r m o a �v ° y ao cc o y Comments/ <br /> Sample ID Date Time Matrix T 0.m a c CL a 0 o z(o W(o a.(o r d 2 � Instructions <br /> inn L'i — t S 16 '�0 t„> 1st C191 S Q,y <br /> 44 40 X 3 <br /> r - - <br /> 1 <br /> Special lnStruclions'Comments Relinquished by e Relinquished by Sample Receipt <br /> Sign i Sign Total no of containers ) <br /> Print -v L�,� IL- S Print Chairs of custody seals <br /> Company. S6 L UV'— Company Rec d in good condition/cold <br /> Time 0 Date S 15 S Time Date Conforms to record <br /> b� Relinquished by <br /> Sign Sign Client <br /> Print / Print <br /> Client Contact <br /> Company Company <br /> Time /5,'-5Z Date52_s Time Date Client Phone <br /> 4G—o1rn <br /> Sr�C]I; IRTRF( Nr 9 !1 <br /> Date 7 1 2 1 q5 Page ( of 4 <br />