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7i <br /> 0 Chain-of Custody Number: <br /> SECOR Chain-cif Custody Record <br /> n Cisco I SC QAdditional documents are attached, and are a part of this Record. <br /> Field Office: <br /> Address: 10 10 P-7 of -' 4 2 Job Name: <br /> Z ic Ca Location: -- <br /> a�� O � <br /> Project#5-00?0,-oh/ -63 Task Analysis Request <br /> Project Manager Xq h C.V �E d h <br /> ;n <br /> Laboratory o r o �' <br /> Turnaround Time a >n `o <br /> 06 <br /> � ' o <br /> Sampler's Nameti `� 0 'd c0u 0 C> c¢ <br /> Sampler's Signature p ruy = c'�a m m [ E <br /> I a �z 2 o. C14 06 0 0 � -W Comments) z' <br /> Sample ID Date . Time Matrix. 3--CO ?—� �- ¢w >" �40 m - Instructions <br /> C:if F3 — <br /> 3 <br /> TX - r� <br /> C1P - 52. <br /> Cr T ), - 101 7_ v 3 <br /> cPTtZ r 2-3V YU <br /> Special Instructions/Co s: Relin€fuishe by: Receiv by: Sample Receipt <br /> Sig Sign Total no.of containers: <br /> Print r !r Print Chain of custody seals: <br /> -r:ersCo pa.ny Company Recd.in good condition/cold: <br /> Time Time ate Conforms to record: <br /> _. pr_s.er5. — <br /> Y Relin shed Received by: <br /> Sign <br /> - n Client: <br /> Print nt lie ontact: <br /> -- ---- _ _-- Company - Company <br /> Time . Date Time Date Client Phone: <br /> SECOR OUSTREQ Rev.V95 - <br /> Date: 12 /-70 1 Page- -of_� <br />