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09 <br /> A0 A <br /> Chain-of Custody Number <br /> SECOR Chain-of Custody Record <br /> Field Office -7�7 <br /> j 'Additional documents are attached, and are a part of this Record <br /> Address - 30/7 Lkm* Jam ,.. Job Name - <br /> l + tio b Location <br /> � CJS tS b <br /> G.7 Analysis Request <br /> Protect# /)72. �O� Task# a _ <br /> Protect Manager X6EP "WLP r <br /> Laboratory r U5 e <br /> Turnaround Time�,! �� z <br /> n �v ice- mU civIds <br /> m <br /> 2� ¢ �� n A U j U <br /> Sampler's Name w a$ �'`" �' o m o <br /> 'E <br /> Sampler's Signature o ec g 0 s$ <br /> aComments/cu ca a <br /> Sample ID Date Ti me Matrix F n vq 1 <br /> n <br /> Z <br /> r. a Instructions <br /> 1wk� o od AYr r — � <br /> 1 w - � <br /> f re w r— 1.a <br /> W - Z(!r t3so Vj <br /> ekwe- 3r lYoa 1 ` i <br /> u� <br /> 410 <br /> Special Instructions/Comments Relinqu+ by Aecerved Sample Receipt <br /> Sign Sign Total no of containers <br /> Print 4.— Print Cham of custody seals <br /> Company f4�x Compan Recd in good condition/cold <br /> Time 4:3b (,q __.Date -! Time Date Conforms to record <br /> Relinquished by Received by <br /> Sign Sign Client <br /> Print Print Client Contact <br /> Company Company <br /> Time Date Time Data Client Phone <br /> Date S, 1 06 Page 'L of 2 <br />