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0 0 Chain-of Custody Number <br /> SECOR Chain-of Custody Record <br /> Field Office 077 Additional documents are attached, and are a part of this Re4ord <br /> Address `6r? t�lC.Gd/ZE 11 /00 Job Name ����-� /14ar.kL ' <br /> .. 12A-4to Location 23 f S.._.., !; -.J <br /> Project# 077. +rza)4 • 003 Task# Analysis Request <br /> Project Manager_ ;EhFF <br /> Laboratory TG o N N ` <br /> U N <br /> Turnaround Time wE a _ �, m ,� <br /> d ❑m �U 7 OU U cc, R U <br /> X+� S N 'O 1 EL N <br /> o c7 _c w <br /> Sampler's Name, r s'�o a o o p ocli m o 1° <br /> Sampler's Signature -- ' �' °' <br /> P g ❑ �� an R� -� O1 �� J �-�m d <br /> U Q o d o a 0 o o C14 0 o m Ln N m o p� O W U 1` Comments/ <br /> Sample ID Date Time Matrix m a =o N o a( � 0- Q, Instructions z <br /> X <br /> s-20 a sn <br /> x �y <br /> gyp, -wn v - �- I <br /> IX <br /> 2- z� 1r9 ;K <br /> Special Instructions/Comments Relinquished by ei Received by Sample Receipt <br /> Sign l- ✓�- -- Sign Total no of containers <br /> Print Z),, 1v 1 r nie Print Chain of custody seals <br /> Company f C` Company Rec'd in good condition/cold <br /> Time )3.3-7 Date 7 Time Date <br /> Conforms to record <br /> Relinquished by Received y _ Client <br /> Sign Sign <br /> Print Print + Client Contact <br /> Company Company �ti. <br /> Time Date Time631— Date G7 q OOQ Client Phone <br /> SECCR CUS MEG Rev 2M <br /> Date -7 / 7 / 00 Page._L_. of 3 <br />