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Chain-of Custody Number: <br /> SECQR Chain-of Custody Record <br /> Field Office < Additional documents are attached,and are a part of this Record. <br /> Address. k Job Dame k r_„ K <br /> Ali o Location <br /> L e <br /> Analysis Request <br /> Project# Oln� 1 g .e Task# <br /> Project Manager I-to K , k <br /> Laboratory Fs,1r W t sV "Int- CO <br /> Turnaround Time _._Nor bo o.N <br /> �N <br /> Sampler's Name +�r' C0,10o p m o 0 0 a° m s s <br /> Sampler's Signature Lc.--- �'.� ,�-- o % s g� g N g �' <br /> =Y x,. - Comments/ z' <br /> Sample ID Date Time Matnx x g ° x �' a ^ ° '' Instructions <br /> W ui C i <br /> Special Instructions/Comments Relinquished by Received by ` Sample Receipt <br /> {{ Sign f c. — Sign Total no of containers <br /> P J Pj- j ��G� t� c� Print r�� Print > .�t 1 h t�f r ;^ _C;Of Chaln of custody seals <br /> Company !S _-1_012 — Company -t a JA_) L, " �' Rec'd in good condition/cold <br /> �j�{v(Z - R�� ►.� l�, JG�wc.. Time KQ, Date 00 Time '/f^,' Dater� � Conforms to record <br /> Relinquished by Received by Client � - . <br /> Sign Sign bn, <br /> Print print Client Contact <br /> Company Company Client Phone,1)L-- - <br /> Time Date Time Date a <br /> sMM wsTREc FAN ago { <br /> Date / / Page 1 of <br />