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Chain-of Custody Number r <br /> SECOR Chain-of Custody Record <br /> Field Office S LollAdditional documents are attached, and are a part of this Record <br /> Address I 3qO `^��1 rbwPJ455 2 3(pD Job Name _MWO <br /> O <br /> CD/)to I Location Ho W- CkG.I"kr WIY <br /> Prolect # fl 0001-oe�, _p Task #C1009 Analysis Request <br /> Project Manager -7�70v) f30"'t-r <br /> Laboratory V 0-C-- <br /> Turnaround Time ST qtr <br /> a� <br /> is <br /> Sampler's Name C ��1 ! w <br /> m E °r° `-'civ �v c� oa m0 cmc civ m <br /> Sampler's Signature �( a,-- E m �W 0 <br /> a �� _� = oa �� °� �, y«i m o� Comments/ <br /> Sample ID Date Time Matrix x m ro H ¢ cD z� n CD a(0 F a Instructions Z <br /> (a'15' HSR I <br /> Special Instructions/Comments Relinqu shed by _ 5 f<.Co� ReceivedSample Receipt <br /> Sign Sign / Total no of containers Z <br /> Print GM Prin R Chain of custody seals <br /> Company Com pan UdL _ _ Rec'd in good condition/cold <br /> Time "00 Date -710 Time -� `� Date 1 I-9c� <br /> Conforms to record <br /> Relinquished by Received by <br /> Sign Sign Client <br /> Print Print Client Contact3DM Bower ^ <br /> Company Company <br /> Time Date Time Date Client Phone q�b� <br /> +t t UI{C iJSi Hf C N+v }�y <br /> Date ' 9 Page _of <br />