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UIL, Chain-of Custody Number <br /> SECOR Chain-of Custody Record Co 9 5 0 Y S� <br /> CAG �� Q j 9 - U Additional documents are attached, and area part of this Record <br /> Field OfficeJ - - <br /> Address 3 T� 5 Job Name �! O1L. — � <br /> SA 5-�, � Location 14000 6-857" W!n)Y <92 <br /> 4%-4333 EN 000 Lo C4g.6F06D <br /> Project# 00 5~ 01-O Task#04LL Analysis Request <br /> Project Manager T!944 t 1 BOW6L Y � <br /> Laboratory <br /> Turnaround Time ST�� _ a N Co �� <br /> mC? �j o- 00 Cd <br /> a r o <br /> Sampler's Name ~ E oN O� �o on �a <br /> rci0Samplers Signature 06E aE <br /> xComments/ <br /> d <br /> z <br /> Sample ID Date Time Matrix z o ro ¢ >°n sn o a Instructions <br /> .sP 56U Wa48' <br /> SP Zb5 e 6 4.$ ';L-t 9 <br /> 5paa20 4 b kJ 7c <br /> la 30 Y q -j0 1 ! <br /> i <br /> Special Instructions/Comments Relinquished b Received by Sample Receipt <br /> Sign , Sign So s Total no of containers <br /> Print 1)14QK 562SM Print Majdj SollvkChain of custody seals <br /> Company 56-c02 Company t e?t tRecd in good condition/cold <br /> Time Date C- Time 3 10 Date Conforms to record <br /> Relinquished by Received by <br /> Sign Sign Client <br /> Print Print Client Contact <br /> Company Company <br /> Time Date Time Date Client Phone <br /> SECOR CUSTREC Ray 1195 _ <br /> Date �3 �S Page—/ of <br />