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Chain-of Custody Number / 2z2/ <br /> SECQR Chain-of Custody Record <br /> Field Office /J-7-7 I Additional documents are attached, and are a part of this FlAord <br /> Address 0!7 urax , ;� Job Name 4 .4 c <br />'Icae--avet Location a-r-Z, lAn ars' <br /> ,C Ik6L4iL,4 . 6,1 ft:N7 <br /> Project# D 77. "12"G �- Task# D Gj� Analysis Request <br /> Project Manager :rAF_+G �,.4z' <br /> Laboratory ,70: <br /> N <br /> Turnaround Time_ 1 W Fee =o ' �� �, OF <br /> I aa�y a m u� O� m r- <br /> 9:6 3 <br /> Sampler's Name N o Ico U o 00 m o o '0o U a° o <br /> Sampler's Signature — m E E o 0 N o °N °o m `m <br /> co <br /> E <br /> �ma oN �a mr ' Q <br /> m Comments/m ¢ �Sam le ID Date Time matrix � xco c0 0.cz Instructions <br /> z <br /> (�1— "7 �- u� �2.D � �; II ✓ l'14-� �/rJ. � — vl <br /> I <br /> Special Instructions/Com ents Relin uishy e Received b Sample Receipt <br /> Sign l _ X <br /> J Sign /_ Total no of containers <br /> Print 'e— Print '�� <br /> � Chain of custody seals <br /> Company GfNL Company Rec'd in good condition/cold <br /> Time 'b/3 Date Time Date Conforms to record <br /> Relinquished by Receivedby Client <br /> I Sign Sign c <br /> Print I Print A Client Contact <br /> I Company Company <br /> Time Date Time I l Date-,621 2&- Client Phone <br /> SECOR(VS7REC Re+2199 <br /> i • Date / / Q Page <br /> f <br />