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o <br /> Chain-of Custody Number <br /> SECOR Chain-of Custody Record <br /> { <br /> Field Office .Soca fo � Addrhonal documents are attached,and area part of this Record. <br /> Address. 301 ja"r" Job Name Ravrr—k J" gpleo l- <br /> ay.cl„4 CordwA CA Location 13SIA -,;, Sat~'q Fe Rci <br /> f 1[ R,ftra Cao ICK-- <br /> Project <br /> Project#-MoT Task# ji I[ Analysis Request <br /> Project Man erJ• ck+ar6its, 1 M <br /> Laboratory e4-ria{� ;ca 1 0o r i <br /> Turnaround Time 0 da { a I <br /> p{ � r <br /> .°Spler's Name a emsSigture C °�N ° oSampler' na � 2!2 <br /> o U <br /> r <br /> v <br /> Sample IDg r E <br /> Date Time Matrix = i� �$ � � � _$ �� � �ti �� � eJ Comments/ 3 <br /> QW" 3 4 O X125 VI/ i Instructions z <br /> I1 <br /> I <br /> h f ! <br /> i1 <br /> Special Instructions/Comments Reim hed' by Received by. Sample ReceE t <br /> S oXyee s TAfi Si n Sign <br /> Punt [r i Air Ga Print a Total no of containers <br /> Company SSS R Company Cham of custody seals <br /> Tobo77�o�1 T7 Time1 Date D Reed in goad condlbon/cold <br /> Time Date Conforms to record <br /> Ua�id Va1yQ. .S�I�,C. Relinquished by Received b <br /> Sign 1' by. Client <br /> Pnnt �I I� Sfgn <br /> Print 1 Client Contact <br /> Company Company <br /> Time f iE Date Time of i Date Client Phone <br /> sECW CLMTRM R.z= <br /> d <br /> • Date —3_ / ,4 /CI-2— Page f I <br /> I r <br />