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-- ----- :nL- <br /> 7 Chain-of Custody Number: <br /> S E C%()'"R Chain-of Custody Record <br /> c�9 5� <br /> f=ield Office: 6117- ?A L7-1 cr it o"rA-�o Additional docume nts are <br /> re attached, and area part of this Record. <br /> Address: 0 f 5's F;z Ife/,ve x6'e Job Name: 71hdIL. - <br /> -ArweX, eee Location:" 1 Y000 0 IwY' <br /> Project# 0 - 061 -o Task# Lo 00,? A lysis Request <br /> Project,Manage% -r. L Bawer <br /> Laboratory 4 0 co 12 <br /> Turnaround Time 5 ar411-1 <br /> 3 <br /> EL <br /> E, C <br /> o.g <br /> Samplers Namerw <br /> Z(01( R WO <br /> 0 <br /> E 9 <br /> Samplers Signature— &=-===1 CL <br /> W) Ln E <br /> 0 12 -a <br /> t Comments/ <br /> CL a. <br /> Sample ID Date , Time Matrix 8 (s&I ED,I P 1.,CrL-MC, Instructions z <br /> 144 LQ 10— 0 7-w-9w <br /> Wo3 of L- iYOL -5oaqtoo iq- <br /> MVJ 10 -71 - 11:1/5 <br /> 146L D <br /> /-I LV/0 - 75 z <br /> M,w /1) - 25 Ig"Zo <br /> 40LI) I. <br /> tAw/(3 - 70 IPS'b *o tad O <br /> MUJ/0 -,/00 )Fo L <br /> 1,2 Yorod- <br /> Special Instructions/Comments: Relinquished by Received by: Sample Receipt <br /> 7 -U <br /> Sign /L Sign nnZ;� Total no.of containers: <br /> 1401- 0 ALL PrintV-V\ Print KfilnVI Chain of custody seals:' <br /> Fuflrlf,�;e 1J1d;r1re,,57. Company n (Z <br /> Company gh&E2 - Recd.in good condition/cold: <br /> Time 15 130 Date 9-1-n Time 115'. 10 Date-0=1 Conforms to record: <br /> r,4X jeXSell,-re <br /> M FRA-761.y' Relinquished by: Received by: <br /> Sign <br /> 7-0 771-1 Sign Client:--.7/ <br /> Print Print Client <br /> (916)6 q8-?OS-A *�A etr <br /> I 107 t 0 tact. <br /> Company Company <br /> Time Date Time Date Client Phone: <br /> 91MR USTAWNev.1195 <br /> Date: 7 131 t-U2-- Page 2 of--�2 <br />