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To ­ <br /> Chain-of Custody Number: <br /> SECOR Chain-of Custody Record <br /> UAdditional documents are attached, and area part of this Record. <br /> Field Office: <br /> q k <br /> Address: 17 3 4- Job Name: <br /> Lbdatlor : il ;n 4r Alwv Re <br /> Project Task#Lods Oa Analysis Request <br /> Project Manager Ul& <br /> Laboratory— CV <br /> ::Kr_e_I C�Pjon, E2 <br /> Turnaround Time <br /> 21 <br /> LIS Z <br /> vJ OON > <br /> S <br /> Samplers Name Cd. 0 0 <br /> -Samplers Signature .r m <br /> 0, <br /> LO - E; <br /> comments/ zm <br /> Date Time Matrix R n.:2 Instructions <br /> 7 L4 H Lig <br /> W LP <br /> M L4/ .6,;%2_5' <br /> 451 <br /> M 14.)RI_ 3z 0 #CLO LJ 5'a <br /> A via — Ll <br /> 4-D <br /> SIDo <br /> - ft'—.- . LI <br /> /4w a — 70 /07: <br /> -7 S. <br /> V, 13 '00 1L4,Y <br /> Special Instructlons/Comments: Relinquished b - Recel d by: Sample Receipt <br /> Sign. -Sign Total no.of containers: <br /> 61AI71'G Print Chain of custody seals: i <br /> 410 Company Ompany <br /> Redd.in good conditlon/cold: <br /> Ti F <br /> bate Time' bate'i WIC-o Conforms to record: <br /> Relinquished by: 1716celved by: <br /> Sign Sign Client:—If-Xf&� 044- <br /> Print Print <br /> Company Company Client Contact: 1AL, <br /> Time Date Time Date Client Phone: 71V-37f-ff?'& <br /> 9ECOR OUSTRE C Rev.UPS <br /> Date: _7 Page of <br />