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Chain-of Custodv Number-_6 <br /> SECOR Chain-of Custody Record <br /> Field Office 7�7 Additional documents are attached, and are a part of this Record <br /> Address 3017 �C�`�Qo.� 4J �•v.'7�� ACE> Job Name <br /> /Cu.,c1.a C�o/`o%✓+�. Location 1W4f;V secs �`g Lo <br /> 9�6 7a <br /> 77.0-.w737. ap. 2- Analysis Request <br /> Project# Task# <br /> groject Manager <br /> Laboratory o m <br /> Turnaround Time PU) <br /> Q. U 2 O 2 1 C C <br /> 2 o �U OU d ur U <br /> Sampler's Name asa ? <br /> o N po �0 7,0 N�o 0r �oSamplers Signature o 0o �N rocr oamvmN <br /> a <br /> `n 0 r <br /> Comments/2 <br /> - E <br /> no n.o a ooN mg moSample Iate Time Matrix 0 _(n N 00.(0 a.2 <br /> om <br /> Instructions z <br /> s g30 r 1 <br /> Special Instructions/Comments Relinquishad Received by Sample Receipt <br /> Sag Sign Total no of containers l <br /> Print Print Chain of custody seals <br /> Company Company Recd in good condition/cold <br /> Time /46.30 Date Wra Time Date Conforms to record <br /> Relinquished by Received by Clientd� <br /> Sign Sign n0,n..... ._,. <br /> Print Print Client Contact�� <br /> Company Company <br /> Time Date Time ? Date 4 client Phone S61'� <br /> sECM CUSTAEC Rft zee <br /> Date $ I 6 AZ Page L—ofl <br />