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1 <br /> Chain-of Custody Number: <br /> SECOR Chain-of Custody Record <br /> C�-1 Additional documents are attached, and are a part of this Record. <br /> Field Office: `� <br /> j t E�SNfss p�.tK /til. iw Job Name: f"9[ cif L C r ;�; , J <br /> Address: <br /> ;7 Location: <br /> Project # 7,) ,:,,o5 / Task ��� �� Z Analysis Request <br /> Project Manager a c <br /> Laboratory G AL"f c (D o m N <br /> Turnaround Time y us - �N " <br /> N V S O <br /> 03 m <br /> 2) <br /> Sampler's Name <Il 7 ' ` iTSCJ'/ U, a 0 o c 'p $ <br /> �� /� / '_ m E E v ia0 mcv mo acv �o �y .. E <br /> Sampler's Signatura��_-- �'' 5-o a a a o ca 0)F2 a5 o� O N yco <br /> o v U '! Comments/ Z <br /> Sample tD Date Time Matrix = �m r w ¢�o _ U)(D (28 r r Instructions <br /> i/' <br /> Special Instructions/Comments: Relin tai h��t by; Received by: Sample Receipt <br /> Sig, Sign rL I� r` url <br /> otal no.of containers: <br /> Print _ - �_�_�fL- I ter\ Print r ain of custody seals: <br /> Company t Uti Company C 4 good conditionlcold: <br /> Time Date t = Ti Time 1 _ `' Date V , ` Conforms to record: <br /> t Relinquished by: Received by: Client:„ <br /> Sign Sign <br /> Print Print l t <br /> Client Contact: . r <br /> Company Company <br /> Time Date Time Date Client Phone: <br /> SEGDR CuSTREC Rer.v95 -,� r [y <br /> Date: ' \ Page of <br />