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Ah Chain-of umber. <br /> SECOR Chain-of Custody RecordJ I `7 <br /> Field Office of 4 <br /> U Additional docume c ed, and are a part of this Record <br /> Address rit v O/C au Job Name L,M C O�L <br /> 5ACi.ow2J -ot <br /> Location <br /> � Analysis Request <br /> Project A-1 -qMO OCL,Task # 1 <br /> Project Manage�re��_�-���-o ,J� <br /> Laboratory_... C f-e., <br /> Turnaround Time _ 'SS NIO t-0 <br /> O m.20 <br /> m o <br /> Sampler's Name �t� -r( Ce25CO 21 <br /> P t"'o nN b� oa mm a°O ° <br /> Sampler's Signatur E �° 00 CM 'CO a <br /> ��' zr r o� ma °� E� vim �N o Comments/ z <br /> Sample ID Date Time Matrix d o a o o a o a�a m o o v <br /> = r CO r CO a 0 N z N a�o a f- Instructions j <br /> i <br /> I <br /> Special Instructions/Comments Reiinqui d Received by Sample Receipt <br /> Sign Sign Total no of containers <br /> Print Print Chain of custody seals <br /> Company Company Recd in good condition/cold <br /> Time Date' U Time Date Conforms to record <br /> Relinquished by Received b Client SC—tO*ti <br /> Sign _ Sign �-o —bow w- <br /> Print Print v atI Client Contact �Z <br /> Company Company, aaecvt 1 rk1A , u0 <br /> Time Date Time Date / Client Phone <br /> SECAR r�STgEC Rei 2199 <br /> Date / � / UJ Page L_ of <br />