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Chain of Custody Number <br /> SECOR Chain-of Custody Record <br /> Field Office 077 Sacramento ❑ Additional documents are attached, and are part of this Record <br /> Address 3017 Kilgore Road,Suite 100 Job Name 7-Eleven Store#17334 <br /> Rancho Cordova,CA Location 4501 North Pershing Avenue <br /> Stockton,CA <br /> Project# 77EL 17334 04 Task# 0410 Analysis Request <br /> Protect Manager Jaff Auchterlonie <br /> Laboratory Kiff Anal ical m W <br /> Turnaround Time Standard ca <br /> c <br /> Sampler's Name Pen V n x m m m <br /> Sampler's Signature g E a m 2 A m o <br /> x a r = a a a E s Comments/ E <br /> Sample ID CL <br /> Date Time Matrix z � co Instructions z' <br /> MW-2 140 dy I,-f95 Water x X X 3 al <br /> MW-3 I—co-o`t 11154 Water x X X 3 °Z <br /> MW-4 L7-zo a i, v5 K Water x X X 3 d3 <br /> MW-5A -too ► `!r Water x X X 3 0� <br /> MW-5B .zo-. ZO Water x X X 3 S <br /> Special Instructions/Comments Relinquishe y h Received by Sample Receipt <br /> 5 Oxygenates TAME,MtBE,EtBE,TBA, DIPS Sign V, I Sign Total no of containers <br /> Global ID#70607700407(SIRC) Print p�AF4 ✓A�y1, Print Chain of custody seals <br /> email EDD to dacadin@secor com Company _s.'eA,.- Company Recd in good condition/cold <br /> email results to dherzog@secor com and Time Date -U.o Time Date Conforms to record <br /> tmiller@secor cam Relinquished by Received b <br /> Y <br /> Sign Sign Client SECOR <br /> Print Print o So 4gAL A&a Client Contact Tom Miller <br /> Company Company fir' Client Phone (916)861-0400 <br /> Time Date Time Dale_p a ext 279 <br /> s>�ast�cw �a <br /> Date Page r <br />