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` I <br /> • �1,te 22 Chain-of Custody Number 2 7 <br /> I <br /> SECOR Chain-of Custody Record <br /> U Additional documents are attached, and are a part of this Reikird <br /> Field Office <br /> Address �.�L7 ,t��� � f a Jots Name <br /> Location vc y� C <br /> Analysis Request <br /> Project# 077V17 Task# <br /> Project Manager r <br /> Laboratory xe- < coo W <br /> Turnaround Time _ a Z o 22 m <br /> FPiv U 2v C7 -a v <br /> a_ao^ =a oo QN <br /> opo o n.—Sam let's Name 7E E Ep riN <br /> � CD ° c' <br /> N Sampler's Signature E <br /> Comments/ <br /> cao 0 vov Oz <br /> Sample IQ date Matrix 00x 0 U)90 1O '`° `D a`O Instructions <br /> =y7 tsi 1 3v r <br /> I <br /> I <br /> Special instructions/Comments <br /> Rehngwshe eceived by - Sample Receipt <br /> Sign Sig Total no of containers <br /> Print Ste' -- Print ZE n1#1) 4! �W LL_ _ Cham of custody seals <br /> Company Company ( K Rec'd in good condition/cold <br /> Time "/-7 Date S Time s Date �s °i Conforms to record <br /> Relinquished by t C Received by Client f' <br /> Sign Sign � 1 r <br /> Print 1 Cl< SCC Sign <br /> S Ar1+�0 Client Contact T' <br /> nt <br /> Com <br /> Company r' �Or2 Timepa Date �� Client Phone S61—ayva <br /> Time. Date <br /> SEOM« Rw <br /> Date 3 � 1� I ItD/ Page of <br />