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0 <br /> Chain-of Custody Number <br /> SECOR Chain-of Custody Record <br /> p I Sr'T�r Additional documents are attached, and are a part of this Record <br /> Field Office <br /> Address I1�Z �1hhu � Stti�-�, C. Job Name .7( a 1� ` Ltii: 1D <br /> ri <br /> C f5�15 _ Location 1`1y 4WI R8 <br /> LV_Ve�r�. �9- -- <br /> Protect# 50110—VVI-01 Task# Ld_`QH Analysis Request <br /> Protect Manager 1-112LO►�Pr _ <br /> Laboratory FKel c4e6jo CD y sv <br /> N � � c <br /> Turnaround Time a o � o �Cz 2 � o <br /> 0� 2 cU Ov V m U <br /> a o �,U m .0 a ? tt2 0 <br /> Sampler's Name C G LU o do 0 o p o m Q Eu o o a m m <br /> m E E , mo mN 0 oil- �o J �y � co E <br /> Samplers Signature --r o =r z^ = o a _o� �L" N m m N oro a Comments/ <br /> U CL.4 �O 'uN �O 6 V U Z <br /> Sample ED Date Time Matrix z �- ¢ _ W a a Instructions <br /> p/tw'k)i 7-19-- 1.5130 t.0 Iwo 3 <br /> Jill <br /> Special Instructions/Comments Relinquished b Received by G Sample Receipt <br /> Sign Sign Total no of containers <br /> VAK ft, 4-s `Tb —70 b p Print L( r Print Chain of custody seals <br /> Com an Company 1 � Rec'd in good condition/cold <br /> B lbwirl N I0 (015�g�sZ Time 9i Date 7'16-Q? Time 3� Date ' ioR Conforms to record <br /> Relinquished by Received by <br /> Sign Sign Client <br /> Print Print Client ContactRitual) <br /> Company Company <br /> Time Date Time Date Client Phone <br /> SECOR CUSTREG Rev 1195 <br /> Date 1 )6--127 <br /> _ Page_ -of Z <br />