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Allik <br /> Chain-of Custody Number: <br /> NEW <br /> SECOR Chain-of Custody Record v t 6 Te)) <br /> Field Office <br /> Additional documents are attached, and are a pa o this Re*brd <br /> Q <br /> Address GLrLGagG= fZe �w - -- Job Name - Dr <br /> CGff,, ✓va 1- C. f1- Location / /-,- ,7_ - - -- <br /> Project# • Z 1 00Z Task# , Analysis Request <br /> Project Manage=o,-'_�- C)Rosd.3 ti <br /> Laboratory CkCCLc L(r^ �o <br /> Tumaround Time `scAtJ]r~ril� co <br /> NCO <br /> O m N C <br /> R _0 yQ , N <br /> ler <br /> Sam s Name °o 'tl <br /> Sampler's 0-1 <br /> Sampler's Signature A a °cv m C m :rm m Q <br /> U ao 0.0a °o oa M0 �cC4 d� ov ' U Comments/ <br /> Sample ID Date Time Matrix * 1-001 �- 7 w z(0 cow ^ a Instructions z <br /> zez ✓6 /Y' <br /> E <br /> I <br /> Special Instructions/Comments Rehnq e laReceived by Sample Receipt <br /> Sign Sign Total no of containers <br /> Print r Sor Print Chain of custody seals <br /> Company_5&-co2 Company Rec'd in good condition/cold <br /> Time '-15' Date W Time Date Conforms to record <br /> Relinquished by Received by Client Stec <br /> Sign Sign --�1 <br /> Print Print Client Contact <br /> Company CompanyL <br /> Time Date Timet� Date 001 N/00 <br /> Client Phone l ' a �w <br /> S�COR CUSrnEC Rev ZM ! <br /> Date ld I Page_L of <br />