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Chain-of Custody Number: S <br /> SECOR Chain-of Custody Record6020462 <br /> w14 • Q <br /> Field Office: Sli K F c :Sr C 5� U Additional documents are attached, and are a part of this Record. <br /> Address: �( LA�� G+ �u�G Job Name: 'r,6o*j9f` P4 v"K hLa K w <br /> LAAZ� ).r_ Cao '7454-y' Location: <br /> CA <br /> Project# iia • 0.24.24 Task# 4749493 <br /> Analysis Request <br /> Project Manager <br /> Laborato ;Cy �o <br /> Turnaround Time Sf-a.of aI a <br /> emo N « <br /> A? = io -E6 > OPV U o <br /> Sampler's Nameo a o <br /> _ U I(l = <br /> To o 00o %�o 6 mo oT m nm0 <br /> _ aSampler's Signature «E \ E _N Eo a ° o Comments/Sam le ID Date Time Matrix = xN ww am <br /> $22 Instructions z <br /> MW-3 12.1-1 4k 153D A <br /> ftw • <br /> Special Instructions/Comments: Relinquished by: Received by. Sample Receipt <br /> 10 Sign Sign Total no.of containers: <br /> Print /t/Yr'/ �o�� Print <br /> I.� � Chain of custody seals: <br /> ' Company 74eP C_ Company Rec'd in good condition/cold: <br /> Time Date -Time 17 Date Conforms to record: <br /> Relinquishe by Recei d by: Client: <br /> Sign Sign <br /> Print /fig Print Client Contact: <br /> Company Company <br /> Time Date L Time /6 S�� Date /9 Client Phone: <br /> MMR CUSI Rev.28B <br /> Date: 11 If 161 Page_,� of <br />