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i ! ! <br /> Cham-of Custody Number 2. _7 <br /> SECQR Chain-of Custody Record <br /> Field Office 7 XAddihonal documents are attached,and are a part of this Record <br /> Address 30l7 4&L4 go pff,/od _ Job Name <br /> ' -'i ell f5670 Location `T S. <br /> Project# IYAP-odd Task# Analysis Request <br /> Project Manager 112116P4LtC /c4 1f' <br /> Laboratory / <br /> Turnaround Time awn <br /> x � <br /> a $ .9 <br /> Sampler's Name <br /> o m - <br /> o oc �V o <br /> v c0 ai. <br /> Samplers Signature o L �E pmff � <br /> .�N OE <br /> Sample ID Date Time Matrix = m m x o o a F r a nstructio s z <br /> f -�✓'� pY -SOI � i' w� —01 <br /> dW 1�! <br /> - 03 <br /> �t Wim{ �t -ay <br /> iwr�v� ! � -vs <br /> -Ulr <br /> ,04 <br /> 'n W--1 V-3 -o <br /> gl� _i o <br /> ' Special Instructions/Comments <br /> Relinquished 4E by Received by Sample Receipt <br /> Sign Sign Total no of containers <br /> C51 r�(Y .•J�T, /e2 + 1� <br /> Print Print Chain of custody seals <br /> 'ei' Company Company Rec'd in good conddion/cold <br /> T Time 11-2-0 ._Date o Time Date Conforms to record <br /> 61061 tb <br /> ' Relinquished byRec ved by Client <br /> VA'& V a1%M b'D 0- S t fu, Sign Sign <br /> Print Print r Client Contact del <br /> Company Compan9l&Af hru l <br /> Time Date Time I ) Date got aZu t Client Phone <br /> SBOM CUSWEc%Y ass <br /> i Date / / /d <br /> n <br /> .._.. �. Page_L of <br />