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0 Chain-of Custody Number • y <br /> SECOR. Chain-of Custody Record <br /> QAdditional documents are attached, and are a part of this Record <br /> Field Office '� <br /> �o f2i'Y CL!yCc+(/ MZOO. Job Name TIMOGt. <br /> Address — <br /> •,p, Location 4Q4,kUa (4 <br /> Project#q6-OGiS- ODI-O/ Task# 00 Analysis Request <br /> Protect Manager r L <br /> Laboratory o 0° �' U <br /> N <br /> Turnaround Time - � a <br /> LD ami i� C U > U U +� N CJ <br /> CL O p�� Q7 -q d N <br /> Sampler's Name 4' H D O CO 90 00co c o o0 m m ami n m 9 <br /> Sampler's Signature ❑ a'�n in E co °* o W °��° 9°6 J N a <br /> U do ao a °o oreu coo a)ccv mo ov U Comments! <br /> Sample ID Date Time Matrix z r W i- a( w _ a'O n a` Instructions <br /> AUA3—(0 t WX \AAol i ct 3 <br /> I M 3 <br /> K 00 H <br /> Special Instructions/Comments Relinquish y Slz Rece d by _ t lne sample Receipt <br /> Sign Sign Total no of containers <br /> Print —�/L. /lar+-Q Print Grp 2 e Chain of custody seals <br /> Company ,✓ Company L:XCe �C1rti e V,-\ — Rec'd in good condition/cold <br /> Time DateTime 1'Z - Date VZO11b Conforms to record <br /> Relinquished by Received by <br /> Sign Sign741 <br /> Client <br /> Print Print Client Contact �IIG <br /> Company Company <br /> Time Date Trme Date Client Phone <br /> CdR CU <br /> SESTREC Rev 1195 <br /> Date 12,it Z IS Page 2 of 2 <br /> I <br />