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Is a Chain-of Custody Number 03048 <br /> SECOR Chain-of Custody Record <br /> Field Office U Additional documents are attached, and are a pG _ <br /> ` <br /> Address S � .(� Job Names <br /> Cl � ^� s. - <br /> .,D Location <br /> 77, ;97. x>� Analysis Request <br /> Project# Tam#. <br /> Project Manager �-�' '� `� / L/V-) <br /> Laboratory <br /> Turnaround Time = N a <br /> Sampler's Name fc Jnr '°'� im <br /> o m 00 0 o m o 00 m o M 9 CO <br /> a r m ° <br /> E p mN 0 >N �O JSamplers Signator a moo �,co rn� _w m0 a Eo mN o oe m JComments/Sam le ID Matri ¢ _ a r r. a` instructions z <br /> 4'D U2) CG q Z <br /> Special Instructions/Comments Relinquished by Sample Receipt <br /> Sigra. Total no of containers <br /> Print Pnnt Chain of custody seals <br /> Company .� Company Rec'd in good condition/cold <br /> Time Z2Z!'� Date Time LYate Conforms to record <br /> Relinquished by Received by Client <br /> Sign Sign <br /> Pant Print Client Contact�l� <br /> Ji6s 00% <br /> Company Company T f-z9 <br /> Time Date Time Date Client Phone <br /> Date G I,�7„„ „_,ID,� Page L of <br />