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4 <br /> Chain-of Custody Number <br /> SECOR Chain-of Custody Record <br /> Field Office D?? SaGrajneA+0 Q Additional documents are attached,and are a part of this Record <br /> Address 2-300 i Igoe Ra, She kloo JobName R"a A&rke4-^Rir er-6o%y%Y— <br /> Qa r o"'o Caraoaa-o C14 q 5670 Location 7-3-S"65di+tict afto <br /> project#67-L_4X83. 00(a--Task# Analysis R uest <br /> Project Mara�er 4 n,Pf A.rcAis'lenit <br /> Laboratory Imoi 4=F Mw I t;c at 1 <br /> Tumaround Time A&C n d and <br /> Sampler's Name c4ge o o OR `{�1 <br /> Sampler's Sigrtaturae i= <br /> Sam a iQ Date Tune Mat= = 9 =S N nstru tictlons <br /> 1400 W —6 <br /> Special Instre ictionsJComments Baling fished by. r tak Ca Received by Sample R"pt <br /> 0Ky5enA4eS ; At Bs G, Sign � Sign Total no of containers <br /> ,r � 1 ftp T Print Qfi l 9*-' CaPnnt Chain of custody seals <br /> Company Secoiq Company Recd In good condition/cold <br /> Time_Date #1 Time Date Conforms to record <br /> Relinquished by Recd Client: <br /> Sign Sign <br /> r_� 4t:A--A1';99 <br /> Print Pnnt 1w%P Client Contact <br /> Company Comyy�j'C- V%0bt- <br /> Time Date Time S 0 Date obi 1 Client Phone <br /> SCOW CUSTFEC ftv.ZW <br /> Date _ 6 f 5 /©E _ Ppge-L of <br />