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Chain-of C ustodv NumhPr <br /> 4 <br /> SECOR Chain-of Custody Record 0298015 <br /> Additional documents are attaur iou, ana are a part of this Record <br /> Field Office <br /> ` /i, '. n <br /> ._5►` . =2O cL Job Name <br /> Address —��� �•�� <br /> Location ^ <br /> Analysis Request <br /> Project# 26 Q2,5 CO 1- O t Task# 00 <br /> Protect Manager ,Is&H & � co <br /> r <br /> Laboratory.6999,,C4+9_199�C4+9_1 . <br /> Turnaround Time o m <br /> S mw CL <br /> as U o C� CJ 7 n <br /> Sampler's Name d� o o W 00 o o 0 0 acn m <br /> p co E o mN m� >N t'o y E <br /> Sampler's Signature O ='in =r = a o L. <br /> m� m cv g Sri a Comments) z <br /> U a o n-o a s o cv o cv w o o m U Ir1StrUCtIOnS <br /> Sample ID Date Time Matrix i—W i- ¢S _�° co'CD d cA P`� 0.,2 ~ <br /> Mw- I w <br /> -2 u 3 <br /> v `3 <br /> Iwo- o oa k x 3 D a <br /> 2 � X S <br /> ivvw-(o oa J3 b 3 <br /> 3 <br /> AAW_ <br /> 1Z <br /> Special Instructions/Comments Relinquish d y jRec by f cine Sample Receipt <br /> Sign , Y _ Total no of containers <br /> print /� `n_C` X -e Chain of custody seals <br /> Company Company 1 � tCV" Reed In good conditionlcold <br /> Time Date Time E 2' Date ' -2-B Conforms to record <br /> Relinquished by Received by Client <br /> Sign Sign <br /> Print Print Client Contact t <br /> Company Company <br /> Time Date Time Date Client Phone I <br /> SECOR cusrREc Rev irss <br /> Date L 1929, Page--L—of 2 <br />