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Chain-of Custody Number 0 <br /> Ln <br /> SECOR Chain-of Custody Record 6 96 - 0 5-,;�6 <br /> Field Office S ��o OAdditianat documents are attached,and are a part of this Record i <br /> � � <br /> Address � �— - ^S` '�" _ Job Name �uCO <br /> S 4%,ititisaai&2 f -CA Location ��,_ �M. fir_ ---�-1- <br /> Project 9 gooaj—ooh- OZ_ Task+ Cyq Analysts Request <br /> Project Manager- �IDhn_ki&t- — <br /> Laboratory B � _ �o °� � u m `y' <br /> Turnaround Time <br /> Sampler'$ Name G`� o a o y o PS <br /> m ucv cr <br /> Sampler's Signature Q � ,� mm m � G� <br /> ,- r a v ° N o- Cornmenisi <br /> Sample 117 Cate Time Matrix x m ►o-W a w z c� ' a` iU- Insirucbons z <br /> 13 11.143 A4 in <br /> C <br /> 51j3 Ir� u a — <br /> --- - - tt I <br /> r <br /> Special Instruction&/Comments Relinquished by Recefv Sample Receipt <br /> Sign -ZzAAJd, ., Sign Total no of coniainets 2 <br /> aTe�Y Print —IS �i ET Print _ Chan of custody seats <br /> f'a X ►25u S ,�n1e <br /> Company 71C Com a 1=� 4= - <br /> p y_- 13 F1ec d in good cand�tiorJcald <br /> Time 11_' `{S Date 5-13$ Time E Date Sr--t3-q Conforms to record <br /> 0/0 qRelinquished by Q x - - Received b <br /> Sign Sign Client <br /> PrintPrin�J< Gam_ "Cnpq Brow i <br /> Company � Compatn Client Contact,�Time QLZ � Dates Q I<a Time Date_ / _ Client Phone ql �i 333 <br /> Date r 13 LZ�L_ Page —of _� _ <br />