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i <br /> • Chain-of Custody Number <br /> T <br /> SECOR Chain-of Custody Record 51(4 (? <br /> Field Office12- Se � fd �,�J0Additional documents are attached, and are a part of this Record <br /> -� _ _.. f <br /> Address 17_3q - 3 q f k S Job Name /�'' di l Lo,kerr'F,rJ <br /> SGc e ra �r epi fd. /A 9S'S/,- 7,a Y Location / 0o 0 o f '.1-a G k,7&1 C <br /> Project # //eoo S —0o -a/ Task# LOCa.a Analysis Request <br /> ProjectManagero, o T <br /> Laboratory t .n =N c c <br /> Turnaround Time e_« y cn coCo <br /> D- m V O� m C F <br /> .90 Vd H <br /> Sampler's Name. q mo m o m a d <br /> Sampler's Signature p "� a a `� E <br /> Sample EO Date Time Matrix m m � a ° a Instructionsz <br /> w 5-239 <br /> 19: lnfa4e- <br /> 17:'Y <br /> e17:'YWE51 3 e-;, 4-,0 3 <br /> w - 7,'oa <br /> Speclal Instructions/Comments Relinquished by Received by Sample Receipt <br /> � Sign Sign Total no of containers <br /> 1`a /M M edr'si*G ��' to, Print ri,.✓n Print Chain of custody seals <br /> Company Gds. Company Recd in good condition/cold <br /> "' (7/4/)3��- 33 �s Time It ,Ys Date S 2 Y-P Time Dates zY-96 <br /> Conforms to record <br /> yS6-o/w Relinquished by Received <br /> Sign 'Sign Client G.H e 61,'I <br /> Print Print �'' D <br /> Company Company �W Client Contact v war <br /> Time Date Time Date 2 Client Phone 7l 379'3366 <br /> SECOR CUSTREC Roy 1195 <br /> Date J z .,.23.1 96 Page of <br />