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Chain-of Custody Number: <br /> SECOR Chain-of Custody Record <br /> Additional documents are attached, and are a part of this Record. <br /> Field Office: �- <br /> Job Name: i- ,� :c — 1. Q+ <br /> Address: <br /> tit S Location: <br /> l G� / 6,52 <br /> Project # '2 Task #�Oz r,Z Analysis Request <br /> Project Manager != � <br /> Laboratory e ' 00 m y v 3 c <br /> N ? i} A <br /> Turnaround Time a o a o N ro o <br /> � U <br /> CL a y o <br /> a. m �v <br /> Sampler'sName�— P•_ {.��Ct<-.���_ �� a� co 00 00 m0 `—°o mCO o °� <br /> Sampler's Signature t '-~ o �+,� o a @ o° E° N .fl a Comments/ z <br /> Sample ID Date Time Matrix z ►°-w w r <w o z w cn� a w r°n tL M f- 5_ Instructions <br /> /A:. / an.4i' 3:30 W1� r.�l X 3 <br /> rf,J. I 2 : 37 1 <br /> V. a - S 3:oo i <br /> tA_J Z. 1 :117 <br /> p...•...a . 1.2.14 <br /> 35 0 <br /> Special Instructions/Comments: Relinquished by'' Received by: ' nk _ Sample Receipt <br /> Sign Total no.of containers: <br /> Print//� Chain of custody seals: <br /> Company _,2 r Cit _ Company Rec'd.in good condition/cold: <br /> Time =1S _ Date ',4 7 Time t' Date,_ : `v Conforms to record: <br /> (7/4)3,6 u-- 1889 <br /> Relinquished by: Received by: <br /> Client: <br /> Sign Sign <br /> Print Print Client Contacts - �`' � 7 <br /> Company Company " <br /> Time Date Time Date Client Phone �� '� <br /> SECOR CUSTREC Rev.1195 - <br /> �y Date: I ` Page of <br />