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a <br /> Gram-off Custody Number _ C= a <br /> SECOR. Chain-of Custody Record <br /> c <br /> Fie'd Office <br /> 7-7 — Additional docurnenls are attached and are a}part of this RArd C m <br /> Address 3W7 [��� 120, -4100 ,lob Name � •�-1�. `� EEM <br /> 0 <br /> HIiC,Ht) 0A• OVA --.,. a7b Location 94 LAKAA$114 &a CD <br /> w <br /> w <br /> Project#-d77- 200�_ astc#-�-- <br /> Analysis Request <br /> Prolect Ma nager , Y <br /> Lobo rato ry <br /> Turnaround Time WMA40 <br /> _ <br /> 0. <br /> Sample".9 Name Oto q c 0 � ti , m <br /> } v CV po nc a yo av y - o <br /> Sampler's Signature , a ma mm g �4N -j <br /> zr i'r z oN �� aT cin ino �cw o J <br /> ID <br /> Comnentsl E <br /> SappeID Date Time Matrix r �� !n m ¢� 7(O 3:(C c° LD ILo Wti 0.2 � Z <br /> { rr� Instructrors <br /> rot 1. <br /> f {S-D I m <br /> _A6 f " P--IS' 13 0 <br /> Z D089Di X A <br /> L" Z.t} d w <br /> CO <br /> Special Instructions)Cornments Relinq b Re;eived by Sample Receit o <br /> Sign_ Sign Total ro of containers <br /> Print_ Qom, e hM&6E& Prll# Chain of cuatody seals <br /> Company rE p.& Company Recd in good conditionlcod <br /> Time_ �e �1` Date 7 Time — Date <br /> Conforms to record <br /> Relinquished by Received b Client _ <br /> Sign ! Siong~ <br /> Print_. ��F Print c' Client Contact -° <br /> Company "- _ Company_ <br /> y _ v <br /> Time— ✓� Date dime_ ��� Date u at Cl1ent Phone <br /> w w <br /> SECGH G3SiHEC Fed gyp � <br /> Date _ � f �� Page,�L of <br />