Laserfiche WebLink
Chain-of <br /> SECOR. Chain-of Custody Record 0398041 <br /> �fo Additional documents are attached, and are a part of this Record <br /> Field Office - - - — -- -- <br /> Address 139 �`'` 0`^ oa 3�v Job Name �'+P O► -- <br /> cot\( U. � �-- - — Location 000 wA-1 <br /> i ar C'fk <br /> 00l_a r- Analysis Request <br /> Protect#�,S Task#_t.cx o5 <br /> Protect Manager W <br /> Laboratory <� f em 4 p <br /> Nr <br /> Turnaround Time U) o , <br /> Name �.-_-.. o o CL -o LL «+o 2 o m ^r <br /> Sampler'sm E E m yN Dcy Cr sN �0 J a. <br /> N g <br /> Sampler's Signature_ ❑ _ 2 r = o g� E N ;9 cu o Comments/ <br /> Sam le IQ Qate Time Matrix i o co a x i f Instructions <br /> THE ..w SA :?/'IQ 73S 'K Y. Iv 3 8 3 i <br /> 6_rr 13170 -1, '-r-0 0R X AO3 <br /> w S a 3110 9'35 03? $ 3S1 2. <br /> T r- '11onI3 A 03 y s 35a z <br /> 0 M 353 Z. <br /> Special Instructions/Comments Relinq=��_ <br /> Received b cr Sample Receipt <br /> Sign ,, Sign Total no of containers l3Print 6A6 C I ti rl- Print rt y Chain of custody seals <br /> Company 5 Q Company N�xf<{ '') Recd in good condition/cold <br /> Time 15 15 DateTime 15'.15' Date 3x_ 9e Conforms to record <br /> Relinquished by Received by sr--calf <br /> Sign Client <br /> Print Print Client Contact !-�f ar <br /> Company Company <br /> Time Date Time Date Client Phone(!)6 % -) ° <br /> SECOFt OU$TPZc0 s <br /> iDate 1 70 1 29 Page_�_of <br />