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Chain-of Custody Number: <br /> SE OR Cham-of Custody Record <br /> UAdditionat documents are attached, and are a part of this Record. <br /> Field Office: <br /> Address: 4 .lob Name: <br /> r Location: — i�,—e, - <br /> Project# f-a 4 0 -0 -- 0 f_Task# Analysis Request V <br /> Project Manager e <br /> Laboratory gft� CU <br /> b-r <br /> c <br /> Turnaround Time a - a-o <br /> c <br /> ' oL, v <br /> R mt7 2 o <br /> Sampler's Mame °�, '�� `� a -Q o- 110 2 <br /> Sampler's Signature , o 40 'CD <br /> c� o g o v 2 0 v � n� °a 5 Comments/ z <br /> Sample ID Date Time Matrix �— > — instructions y <br /> 4 S <br /> 59- 1 <br /> Special Instructions/Com ts: �,., Relinquishey: Received by: Sample Receipt <br /> Sign Sign Total no.of containers: <br /> -'Please initial: Print tip Print Chain of custody seals: <br /> Samples Stored in ice. Company Co ny Redd.in good condition/cold: <br /> Appropriate containers Time 1 Date � � [me ate Conforms to record: <br /> Samples preserved Relinquished by: <br /> T)b - <br /> VOA's without headspace_ Sign Sign y Client: �'b GoiZ <br /> Comment Print Print Y&I <br /> Client Contact: Pte• Ata, <br /> Cc►rnpany Company <br /> 4 Time Gate Time Date Client Phone: � `�,) x <br /> SEC9R�US7REGRea�lQS- <br /> _...�. . Date: Z Page of <br />\- <br />