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I <br /> Chain-of Custody Number <br /> 1 <br /> SECOR Ch ' <br /> E I <br /> ain-of Custody Record <br /> I7 Q Additional documents are attached, and are a part of this Regard <br /> Field Office <br /> Address! 3&17 C." � Q II Job Name <br /> E I &ALX r 6,opV,4 G Location /Li g 1 AA14 Gi4 - - <br /> Proiect # 077. Y200 (0 ash# O�3 I Analysis Request <br /> �I <br /> Project Manager + ;G <br /> Laboratory.. 41 FF o ;� rN L <br /> W 0 U d <br /> Turharound Time / WC&je= — a m ', in € �,�n wco <br /> - <br /> { m d a 6 EU OU U `+d 0 <br /> Sampler's Name w –3 l4 °' <br /> Ini+fi+ /� m E a E j�IT chi N p o o °^ ro a°r , a iu <br /> Sampler s Signature �,�- m �c 'CO _j r a <br /> i ° z�' x`� = o�, v s E; 'q N o�, S r Comments/ ; <br /> Y= m a COa a( <0 x V)w, 0.0 a — Instructions z <br /> Sam le ID Date Time Matrix � I <br /> 7/1149 <br /> f- 1 p IISD ✓ ' �z <br /> I <br /> ik <br /> s _ v <br /> f'20890 <br /> 010s <br /> Z" w o II 6 ✓ - �� <br /> 11612.— 29— d I icy <br /> Z _ ov I fzL <br /> Special Instructions/Comments Relinq b Received by Sample Receipt <br /> Sign Sign /' Total no of containers <br /> Print 0,6.,%j f Ltai mE& Print�. /r Chain of custody seals <br /> Company {rEc.O2 Company Rec'd in good condition/cold <br /> TimeIiG t'J� Date Time Date Conforms to record <br /> r I <br /> Relinquished by Received b Client <br /> Sign I it Sign, <br /> Print I -_ Print cs Client Contact <br /> Company Company <br /> Time Date Time 161 Date OU Client Phone <br /> SECCR CUSTREC Rev 2199 <br /> iI Date —71 2y 71'r/ coo Pag* of <br /> , <br />