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Chain-of Custody Number: <br /> SECQR Chain-of Custody Record <br /> Field Office: <br /> 01-7 - 73 y"4 .5;k �� UAdditionai documents are attached, and area part of this Record. <br /> �"�� ° <br /> d/Ar OILI - .S88.2 Bolsi Ade, _ 7.4 F/eoI Job Name: M� ell' <br /> Address: <br /> �l �' muoo <br /> u� .n . e � � Location: -- - -- , <br /> Project# <br /> 7/0 -001-01 Task# Lac o x Analysis Request <br /> Project-Manager T.LA - • r <br /> Laboratory e— 9 a <br /> Turnaround Time S a a cO q g cn <br /> 3 09 8 <br /> Sampief s Name 71-'l 10%A/^ m N g O y n. s a. T . <br /> r <br /> m N O <br /> Sampler's Signature—, =c s o ns o E o m 23 Comments/ z <br /> Sample ID Date Time Matrix z �-co a a x ia; c°li 0 �� H n a� �- Instructions <br /> /1 W/o -5 7_.?/�6 $;1S SOIL- goi. <br /> M W/O --)O 10 <br /> M w/o - 1S S; Y13 40 L 'D ro� l <br /> SOLD <br /> w 10 -:Z5- 9;os µa D OA q <br /> Mw1O -:30 , q:1 14,41 z <br /> 11w10 --14o <br /> Kw,ro HOLO I <br /> -�o` lo;35 �EFut$- 144 t./ z e- <br /> PA 0 ' S `y lGi50 Trb� 5 0JP <br /> Special Instructions/Comments: Relinquished by Receiv d by: tJ.K Sample Receipt <br /> llaL D A t L 35XI 155 VNT/4 Sign. �� Sign 4S M.P. Total no.of contalners: <br /> f�Q r/fG 2 1�OrlC�. ✓ Print Print Chain of custody seals: <br /> Company SEfo2_ Company 2t►r1 Recd.In.good condition/cold: <br /> F,,f x kprvLr5 km m i"Olil TEL Y Time Hr: 3o Date -31- 6 Time J `j'�3a Date Conforms to record: <br /> f o ; r..1J Lir.w n Relinquished by: Received by: <br /> Sign Sign <br /> Client: T l`1� OIL. <br /> Print Print <br /> Client Contact: -.kl Bow", <br /> Company Company <br /> Time Date Time Date Client Prone: /q 377.3394 <br /> BEGqR CUSTREG 9W.1/95 <br /> -- - Date: 7 131 11713 Pap-.N.'I_o f a <br />