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9 Chain-of Custody Num <br /> k <br /> VVr 01 SECOR Chain-of Custody Record <br /> Additional documents are attached, and are a part of this RArd <br /> Field Office <br /> Address 3017 A,42,-; Job Name e G� <br /> Location i r <br /> Analysis Request <br /> Protect #a 3 rte— Task # <br /> Project Manager <br /> Laboratory e 1 c a m <br /> Turnaround Time CO� <br /> O m c <br /> Sampler's Name ���4 �� o a o m U p o _� I � ° v ° <br /> + 03 <br /> m E E mo w 0 °cu no � ? w � <br /> Samplers Signature _ O �,� Eco m rnco 0o m 2 a <br /> U zao ao a Eo oN �o aEiN wo o� Q V Comments/ Z <br /> Sample Ip Time Matrix = co r-co a > z�o ur a a �- Instructions <br /> �7 is , r FCC1C}I Z 7 <br /> Special Instructions/Comments Relmquishe Rec ived by Sample Receipt <br /> Sign - Total no of containers <br /> Print Print Cham of custody seals <br /> Compa y Company -CCx Flec'd in good condition/cold <br /> Tim& e i � 'dime 60' Date � Conforms to record <br /> Reli quished by Received p y Client -,1- <br /> Sign Sign <br /> Print ru Print a r Client Contact <br /> OCom �� <br /> 7imepany Date Time pan_Company <br /> Client Phone <br /> 9ECOR CUSTREC Rw 2R9 <br /> Date 1 I 1,7101 Page of L <br />