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a�[3 Chain-of Custody Number <br /> r SECOR Chain-of Custody Record (a 9 5-oaf q <br /> Field Office SAUZA4�61 }TO 1. 0 l 9) Additional documents are attached, and are a part of this Record <br /> TU STP-66T- Jot? Name 'r1 1J.. E d I L -- L.00 K_6TO - -- - <br /> Address � ` - - <br /> SAr�eA Location 14000 eiAST O -Y I'B'S -- <br /> 9t(D) q% - 4 S 33 FAC (9/� 456- UZ n L�c�t, C_ <br /> Project#N 'D CC"(- O ) Task# L64-®Z— Analysis Request <br /> Protect Manager, .T6HM E6Uj( K <br /> Laboratory <br /> O3 C <br /> Turnaround Time ._ 766JaA m QV) U o �� y <br /> Q = C Q m O <br /> Sampler's Name LUo a o W o o`o 'o n o y o �°r m o <br /> E E N <br /> Sampler's Signature o f W O m ")m . - a E <br /> U a.o a o a °o O N M o m cv m o r °m U Comments/ z <br /> Samf le ID Date Time Matrix = i-co CO ¢to to �c0 cn�0 4(0 �r. a-Z. i— Instructions <br /> Z �h3� VQ 45' 4a;i-q-L <br /> p9 by a k.) ' 3 z <br /> (--),9 U c,sZw Z, <br /> S X e z <br /> (o cisb x V QAo 4s v16 2- <br /> D 7 <br /> XVO a,514 <br /> Special Instructions/Comments Relinquished Received by QN0,6 Sample Receipt <br /> Sign Sign C Aul. Total no of containers <br /> Print MoVU Print . �n�.� ��,u�y5 Chain of custody seals <br /> Company 5q—'O'Z Company ��(- E dI kA Recd in good conditioNcold <br /> Time — Dat ` 3 Time 3 Citi Date�� Conforms to record <br /> Relinquished by Received by <br /> Sign Sign Client <br /> Print Print <br /> Company Company Client Contact <br /> Time Date Time Date Client Phone <br /> SECOR CUSTREC Rev 1195 <br /> Date _ CO_ 1.23 i Page I of <br />