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Chain-of Custody Number: <br /> SECOR Chain-of Custody Record <br /> �o o l A Additional documents are attached, and are a part of this Record. <br /> Field Office: Lp u r-J7 e h-/S <br /> Address: 3 OWIT/6 ti✓ J S 6 Job Name: <br /> ro v-)n2 Location: 4 ° eA- <br /> Profect# 0 y- 00 OZ Task# Analysis Request <br /> ' lg `n <br /> Project Manage S / e <br /> Laboratory r 0 N a _ <br /> Turnaround Time h a a ," o 2 <br /> Samplers Name �Ij Fo a� of �N O� �o roo0 om <br /> SamplersSignatur x � <br /> a 0N 016 <br /> U Comments/xx z <br /> 0W CL 2 <br /> Sample ID Date Time Mat = 0 > ° ' <br /> Instructions <br /> s s Gas ' 3o S <br /> s <br /> s ' <br /> J Special Instr tions/Comments: Relinquis y: Received b Sample Receipt <br /> T { Sig Sign Total no.of containers: <br /> VI yj q .f-Ulf I fru t'�/vl°) Print a"iec Print r Chain of custody seals: <br /> / Company Company Rec'd.in good condition/cold: <br /> Time Date Time CDate Conforms to record: <br /> Relinquished by: d Received by: Client: <br /> Sign Sign <br /> Print Print �� s Client Contact: <br /> Company Company <br /> Time — Date '7"/ Time —�� Date r Client Phone: <br /> TfiE flw.VPS <br /> Date: 3 1 3/ Page of <br />