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Chain-of Custody Number 6r4t�, <br /> SECOR Chain-of Custody Record <br /> Field Office CF7-7 S4 C-M fne Ai-O U Additional documents are attached,and are a part of this Record <br /> Address 301_71i Kid or- Rik S-Fe ISO ,lob Name kar'6' Mai-ke* <br /> ar r_kv Gordov4 CA qE% 0 Location 2320 Sau*-h Sam P004 <br /> %yer_�A'kIC, Cao 4s <br /> Project#71bT,434z2,0 Task# 0°O2 m Anaiysis Request <br /> Project Manaaer Ja Aolixi i e. <br /> Laboratory F t 42 Ami-1 ca <br /> Turnaround Time la da S S#andArd r U m <br /> Sampler's Name 8r• i GR W >N o g a o1 a°y m <br /> Samplers Signature € Q m 2 m m a Ql 2 -1 a <br /> Sample!D Date Time Matrix = m do _ ro a g Comments/ <br /> Instructions Z <br /> 9 dL 0-7 ZS- So -011 <br /> s 7 M30 -07 <br /> S� 3a u73S _0 <br /> S 0740 <br /> i <br /> 2d <br /> %as <br /> I - <br /> S-t7 30 180.5 <br /> -t-7 3 jots <br /> 014 <br /> Special Instrucbons/Comments Relin heFd by Received b Sample Receipt <br /> ;v 1plml Z ) TNO77 004'7] Sign Sign Total no of containers <br /> i a , Pnnt f pan +^� Print l <br /> V �a �� �51 R G Cham of custody seals <br /> Company S[ CoR Company_Kf <br /> Time 32-t 0 Date 7� e -- Recd in goad conditivrecord <br /> Time- LiSt�' Date t <br /> Conforms to record <br /> Relin fished by Recd ved by <br /> Client <br /> Sign Sign <br /> Print Pnnt Client Contact <br /> Company Company Client Phone <br /> Time Date Time Date <br /> seCM cmc aw 2M <br /> Date I ` I0Z Page of <br />