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1 I <br /> Chain-of Custody Number: <br /> SECOR Chain-of Custody Record <br /> Additional documents are attached, and are a part of this Record. <br /> Field Office: <br /> Q u/ s-r S a Job Name: C h Z14 V if e tiffs' <br /> Address: u F ✓off <br /> v' SZ Location: <br /> s <br /> Project# ' 1.3'7`0 y' ©Z Task# AnalysiRequest <br /> Project ManaS� <br /> Laboratory <br /> Turnaround Time a m d w iR� <br /> :60mai io > C U U m y <br /> ¢oame / a <br /> Samplers N <br /> E <br /> m Em Comments/ <br /> - oo nSamplers SignatUr o 2�2 fN o Z <br /> U d0S0 oV Instructions <br /> Sample ID = m <br /> (0 "F 1 �a f <br /> S � <br /> Special Instructions/Co ments: Relinquis by Received b : Sample Receipt <br /> � J� �/ n Total no.of containers: <br /> 1'14[U peL ti yf1'r'Jc1b(n Sign <br /> I Print CO Print r Chain of custody seals: <br /> / Company E Company Rec'd.in good condition/cold: <br /> Time Date <br /> Time 10-e Date Conforms to record: <br /> Relinquished by: Received by: <br /> SignClient: <br /> Sign <br /> Print � ' Print G rccY?s Client Contact: <br /> Company Company <br /> 47 <br /> Time /&_Z Date y'/'y TimeDate / Client Phone: <br /> / 3/ , 95 <br /> Date: Page—d--of <br />