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a i <br /> Chain-of Custody <br /> SECUR Chain-of Custody Record <br /> Additional documents are attached, an o this Record <br /> Field Office ------ <br /> Address J� 1 t1E W ,lob Name - <br /> p� <br /> Location -oC,V��v <br /> Project# (7-3 05)Z Task# S� Analysis Request <br /> Project Manager o 20✓� ~` <br /> Laboratory ElrCCL CL,r_-zt, <br /> Turnaround Time <br /> a as _ x <br /> m co o <br /> Sampler's {dame aLU <br /> ° go 00 to o 0 0 m o <br /> Sampler's Signatu ,» U v E m m m o m w Y p E <br /> r r r E N N `s Comments/ <br /> U 0.o 0.o 0. � ocv mo 'D mo pv U <br /> Sample Ib Date Time Matrix m 8 =. 80( a 1D �" a` "' instructions z <br /> 04 <br /> I <br /> I <br /> Specia{ Instructions/Comments Relin I edN Received by Sample Receipt <br /> Sign ` Sign Total no of containers <br /> Print a t r Print Chain of custody seals <br /> Company Company Rec'd in good condition/cold <br /> Time Date Time Date Conforms to record <br /> Relinquished by Receiv d by ClientU� <br /> Sign Sign <br /> Print Print Client Contact <br /> Company Company <br /> Time Date Time + :rC� Date Nn/ 14- Client Phone <br /> L L�Aj <br /> 5ECOp CUS7REC Rer 2H9 <br /> Date / LV � Page–L of . — <br />