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Chain-of Custody Number l <br /> SEW'D Chain-of Custody Record <br /> �Additional documents are attached, and are a part of this Record <br /> Fie Id Office € j <br /> Address <br /> 17 L QD Job Name t <br /> '' <br /> � <br /> � Location �' 2�i4,yiE _ CA <br /> �_ - -- <br /> Of <br /> I� F <br /> Projectl# d77, Y2-1,1)(o Task# 00:9 <br /> Analysis Request <br /> Project Manager T+4rmr. l4c _- Ta&V l T ± _ <br /> 1.Laboratory K/�� � r { <br /> Tui naround Time s1'a�• / w e,� -- a = �, u, a 1 <br /> o� cV OV U m U <br /> r _ - o a�C7 0- o <br /> Se mpler's Name iia o a o c7i N O o 0 0 m m �°r) d ' 6 <br /> Sc m ler's Si nature_ n� - �, � E a m m ro -CO � m o 0- M <br /> p l g a r =`,r-' = o c� 5 v °_ E cn u,co `� Comments/ z <br /> ISam le ID Date Time Matrix i F c c <( ( _(0 m w a Ei Instructionsrd-4L 81t,,1W 12.3b Z <br /> I IE <br /> - <br /> E r G l <br /> I <br /> - <br /> li l <br /> l' <br /> Special Instructions/Comments Relinquis lE y Received by Sample Receipt <br /> Sign I Sign Total no of containers <br /> Print OAij jj± /t€/n& Prmt Chain of custody seals <br /> Company al E'er Com Recd in good condition/cold <br /> Time 1 f'7-Af)A* Date 86,11yo Date Conforms to record <br /> Relinquished by Received by <br /> Sign Sign Client <br /> Print Print Ma e Client Contact <br /> Company--"-- <br /> ompan Company l <br /> I Ti Date Time _ 90 l to Date is bo Client Phone <br /> i <br /> SECOR GUS7FaE ev 1195 <br /> I [��titivt� Q� Its <br /> 1 sl e rra Expnss A <br /> ti�G Date t 00 Page. of <br />