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f <br /> Chain-of Custody Number <br /> SECOR Chain-of Custody Record <br /> Field Office b? o G rct NSP A U II <br /> 7 � _ ,. a �Additional documents are attached, and are a part of this Record <br /> Address �°17 _ a R d S+e t Job Name7- <br /> c�nc�no c,f lova CA 9 S(7U Location Z sb cr4 <br /> f60A C14 g -:Z <br /> Project# 7 014 3bZ 7, d °co Z I I Analysis Request <br /> - <br /> Project Mana er 6 'f-er!ani 2 1, 'D <br /> Laboratory + +c ,, <br /> � U <br /> - " Turnaround Time lo 'Zi C -5 _ <br /> ern I m <br /> n <br /> 06 mom+ <br /> Sampler's Name—I� r as N C a t,0 it a r -3 06 2 m a N e-d <br /> Samplers Signature I -: �v ro a �.� `C° o <br /> O v m� om rnm Qil-in IIQ Y'" �` �} <br /> U .` <br /> 2 2r 2 EN roV �r E� N� YCV <br /> T pro J N <br /> Sample ID Date Time Matnx w ¢w _ v� a a o Comments/ <br /> ' Instructions Z <br /> 134 g- \/ f <br /> II <br /> 11 n i <br /> II <br /> II <br /> If <br /> Special Instructions/Comments Relinc�wshed by Received by Sample Recei t <br /> -5 OXy�� �.� � ', lflt(3 I~f L t� I� Si n L��-- <br /> Print Sign <br /> Total no of containers <br /> Chain of custody seals <br /> _ Company S Cil Com Rec'd in good condition/cold <br /> t= 61o6a 1 r D # Z'o(,O"770p 477 Time 16130 1I Date N Z me ate _ Conforms to record <br /> V a1 ,d VAL-e- Relinquished by Regi ed b <br /> Sign I �! Sign n`'*<J Client <br /> _ <br /> Print ' Print - Client Contact <br /> ComY Company l-l- \rte*L iT <br /> T e t Date TimeL Date- <br /> Date <br /> Client Phone <br /> SECOR CUSMEC Rev 2M I <br /> Date /L4 /U 2 Page* of <br />