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l <br /> • Chain-o# Custody Ni <br /> SECOR Chairs-of Custody Record 797036 <br /> _ I QAdditional documents are attached, and are a part of this Record <br /> Field Office sic �t M c ti"'�a <br /> -7 7 `T, b a+ 2 0 S Job Name � i" C?/L — Lt ep b ► ct <br /> Address � Location lyac`cj - f1 ``'�Crg 9s��S` <br /> Analysis Request <br /> Project# it c Zt —,>I Task# L 6C--t <br /> Project Manager u� <br /> Laboratory - 0 o m Cq It � <br /> EZ <br /> Turnaround Time a oCL T L) o (z y a <br /> _ o �,c7 <br /> 0 co <br /> Sampler's Name 5 M o w N O o o <br /> ' E `�� m� °1m ?Nm a Jr E <br /> Sampler's -� o a N o -'JComments/ z <br /> Sample ID Date Time Matrix m m a a(0 �0 (0 W Co a-( r- Instructions <br /> M Z <br /> M -- <br /> 7-14 <br /> MW- 7-) )2')5 7$ <br /> M tt/­7 7-1 r1loo <br /> 7-) q'so X 8ti <br /> `)S � 8 <br /> W-/6 1-) to, <br /> IQ Wo <br /> Special Instructions/Comments Relinquished by Received by fA&Low�� Sample Receipt <br /> Sign Q Sign �i Total no of containers 30 <br /> 1A?A E' �/ -j�c� Print GAN i2•Gl'VE Print Chain of custody seals <br /> I Company IF-toK Company Q Recd in good condition/cold <br /> Time 6 Ua Date 7` Time J DatConforms to record <br /> 1J._t.,,1 D& ®r O M-9o5,�2, <br /> Relinquished by Received by <br /> Sign Sign Client ? <br /> Print Print Client Contact 12J 2"0 <br /> Company Company <br /> Time Date Time Date Client Phone 6 -3` -0 <br /> SECOfi CUStREC Rev 1195 <br /> Date -7 1) 6' /q7 _ <br /> 97 - Page_J_of Z, <br />