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f N li-V f;;/-Iy 6/031 <br /> Chair:-of Custody Number <br /> SECOR Chain-of Custody Reedrd <br /> p <br /> Additional doc ments are attached, and are a part of this Record <br /> Field Office <br /> Address 73 3 y Job Name <br /> :�G e1 a Or+ a ' ' « 9STIZ - 7o a 4 location •' a <br /> 9� ... <br /> 0 <br /> Project # A7Do - 0o 9 -/0 Task#fQ,*2 Analysis Request <br /> Protect Manager w ct- <br /> Laboratory coo y <br /> Turnaround Time � J a <br /> wn RF dSD 2 y VJ 5 po m <br /> a m i3 j ppb Ao r o <br /> t�7 a m tv7 Ov j _h <br /> Sampler's Name zazs 'a Z R m 7 ° <br /> o a� <br /> Sampler's Signature a �°,e m �,� m o <br /> xr x"' = pEc i°v �� Eur 'v,� �N G ° -°'+ t Comments/ } <br /> Sample ID Date Time Matnx i <br /> CLS �m � ¢t w _(D W� a t r- a instructions Z <br /> Jt,t w _ 3 a -239tot,$6 %+,e3 <br /> Special Instructions/Comments ) RelinquishedZZ by <br /> Recei ed by Sample Receipt <br /> f d r * �u��S �',►�w,Pc+,4 P1r' �o Sign / Sig Total no of containers <br /> Print eAw w.+ Pring KIk Chain of custody seals N <br /> J n k n g o w e f (11,g) yr ' 0 f 1 Q Company S e d Company Rec'd in good condition/cold f <br /> Time0a 'y.S Date -2K-?4 Time L4-,SD •—b6te <br /> Conforms.to record Y <br /> Relinquished by Received by <br /> Sign Sign Client n G D <br /> Print Print Lot r c,r c�^ Li A <br /> FP, r Client Conta�t <br /> Company Company u a•�fr a <br /> Time ,2�,9� Date s��` Time �Date C. Client Phone <br /> SECOACIISTnFrnm im, 7 ~ <br /> Date _J 1% Page of <br />