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Chain-of Custody Number <br /> SECOR � Chain-of Custody Record <br /> i <br /> Field Office 77 ; I �r >(Additional documents are attached, and are a part of this Record <br /> Address lo lea Job Name <br /> _d�-,�✓v�ND C. a206L.A, �/� x'56-7 G '� �f Locations ��Jb`1' S, ?^ l� ACJ <br /> I �k A, vXX41ftiA� <br /> Project# G7 � -'7'GG Task# ,I 1I Analysis Request <br /> Project Manage A A Lfti �, <br /> Laboratory N N f y <br /> Turnaround Time x-IA-41*0 �W��� = r �.-. <br /> Q <br /> �Qa <br /> 02 m <br /> 'Sampler's Name WA �✓ 4t °` � <br /> d ��- <br /> U°v� o po myo <br /> M r- CD a aSampler s Signature o ° 0 0 y"R <br /> Date d mNm °o v Comments/Sam le ID Time Matrix a <br /> Instructions z <br /> pfd tiAT6T <br /> F V <br /> r <br /> tl �I <br /> �! II <br /> Ir_ fE <br /> - <br /> 1 <br /> Special Instructions/Comments Relinquished b Received by Sample Receipt <br /> ,x (5) �� ra�GA� Sign Sign Total no of containers <br /> PrintPrint _ Chain of custody seals <br /> -5 Company S,�' BIZ Company-----L--_ Recd in good condition/cold <br /> Time ?f7-05' Date I C © Time Date <br /> 61:-1 z O tL 't p 6 t I S 030-7 9- Conforms to record <br /> Relinquished by Received b <br /> _,�6 <br /> Vai�v� �fl >� 5 t.�.[„ { II y � a Client ��'� <br /> - <br /> Sign T Signc+ �l Tat,✓ .. <br /> Print 11 Print �^ t� Client Contact �� � <br /> i ' <br /> Company Company r. 1 �F 7 c ,;L, Y <br /> Time Date Time Z Date i c,s ?1 Client Phone <br /> MOOR GUSTREc Rev 2199 it <br /> . w . Date -1-4� / r /G� Page of <br />