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Now Chain-of Custody-Number <br /> SECOR Chain-of Custody Record <br /> Field Offill 0-7 7 Sa crck"oilli Additional documents are attached, and are a part of this Record <br /> Address or 00 Job Name a h r r <br /> 9 S Location 2,3SV S o h Sa n te R <br /> R;V qui <br /> Project#--a( 43 LZ7,oo non2 Task# Analysis Request <br /> Project Manager a Lf. Aue-M-Pdil .0 <br /> Laboratory I c a <br /> Turnaround Time °' 4 <br /> 2 w ro NMI <br /> 2U o CO 4 sm � <br /> Samplers Name vo 2U o o <br /> >J. mJma oCIN <br /> M aT s <br /> U°E 00 Samplers Signature = m ° °E =' a 4)Ca U') CO w Sample ID o m VO Date Time Matrix 100 1 z w a Comments/ <br /> xr <br /> ll- <br /> i — Instructions z <br /> Special Instructions/Comments Relinquished by Received by Sample Receipt <br /> S oxy �+�GeS: lA#gam -t-q M Sign mac.,. _ Sign Total no of containers <br /> -r S A r DI P Print Print Chain of custody seals <br /> rr i Comp any S�CO <br /> E�rp�i � Company Rec'd in ood condition/cold <br /> Time f �� Date G `� r� Z. Time Date 9 <br /> 06�g O 4 7 7 Conforms to record <br /> Relinquished by 7Received <br /> va1',d Vailve #i<5I P� Sign y Client <br /> Sigill <br /> Print Print 14V Client Contact <br /> Company Company —141-- <br /> Time Date Time D Date GS�Z Client Phone <br /> SECOR CUSYREC Rev 2199 <br /> Date / / Page of <br />