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0 <br /> Chain-of Custody Number <br /> SECOR Chain-of Custody Record <br /> Field Office 0 -7-7 LtfAdditional documentsareattached, and are a part of this Re(#brd <br /> Address _._,_— b t 7 1C.� �,�. �Qa Job Name /ts�-4Ac:e AfAtAaT <br /> Location _ U� iUcC . 64 <br /> Project# 0 - X44°(+ Task# 001 Analysis Request <br /> 77 <br /> Project Manager ' kc-�+'rt.xx_y ,I w <br /> Laboratory rI� 4 m N <br /> Turnaround Time l t��`F� Ca <br /> a� Qa d <br /> O <br /> u� ° � m o <br /> w m c�j mU d y U <br /> Sampler's Name w a s 2CO m e w v o— 1° o <br /> p H o o y O� c. 2 a W iy IL g i a� <br /> Sampler's Signature o rn E vC':) °' a,� 'C* r y X <br /> _ a <br /> Sam 1e ID Date Time Matrix v a b a b a °d o N o m N iv o o v o m ~ nsrtnruct ons <br /> x r ao rm ¢0 �( =w uy�a a�a r-r� a`� z <br /> Z-3 -1 Lr 84LO c.O I - z, <br /> Z- 4o 07ro I E/ l -2z <br /> z- w( -z� <br /> L ✓ 1 -24 <br /> ID <br /> rll�l 60 DS7 ✓ <br /> re 2 - /too leo - 77 <br /> Specia n uctions/Comments Relinq�T?2_ Received by Sample Receipt <br /> Sign 0 ` Sign ___.___ Total no of containers <br /> Print 0�N S Print Chain of custody seals <br /> Company AEKD4 Company Rec'd in good condition/cold <br /> Time 14;1-';- 7 :G "Date Time�Z—Date Conforms to record <br /> Relinquished by ---Received b — Client <br /> Sign Sign <br /> Print Print Client Contact <br /> Company Company <br /> Time Date Time 6 Date 7 7 Client Phone <br /> SECOR CUSTAEC Rev 2199 <br /> Date / -Z-f- / OU Page--.!,L of 3 <br />