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Chain-of Custody Number' <br /> SECOR Chain-of .Custody Record <br /> Additional documents are attached, and are a part of this Record. <br /> Field Office: ti 4^y lel !--4 <br /> Address: d Y't" ° +� Job Name: <br /> p — Location: <br /> Analysis Request _ <br /> Project # 5-0 3 -O U -D Z Task # <br /> Project Manager t <br /> Laboratory �2 _ a <br /> Turnaround Time ° �_ a 0o A 2 <br /> N N <br /> Q .G <br /> 00 U ' <br /> 19 <br /> Sampler's Name G ° Cd Q N O Q o o N Q 'a a� a �L y <br /> Sampler's Signatur o Ln = r ';� o 'E 'N CO a N .d a rr Comments/ z <br /> U o ao a °o acs 90 mcg mo ov °i U 0 <br /> Sample ID Date Time Matrix x �-m CO `' a �` Instructions <br /> S 3 '`Z ✓ 7- 23-1r15720 <br /> 513 --3 3 i 2 Rb 'oo <br /> r 5- <br /> ef <br /> If4LHId L <br /> Relin uish b Received by: Sample Receipt <br /> Special Instructions/Comments: q Y <br /> I, Sig Sign Total no.of containers: <br /> V� Z �( l'� Print Print Chain of custody seals: <br /> Company_ 5- Company Z Recd.In good condition/cold: <br /> Please initial: Time r Date Time Date Conforms to record: <br /> Samples Stored in ice ! Relinquished by: Rbceive y: Client: <br /> Ap proprilate containe — - - e Sign _ Sign <br /> t Print Print Client Contact: <br /> eserve� <br /> �1 's vrit'3oLt haodspace Compa Company5 f <br /> Time Date 'rime `�., Date =� `� client Phone: <br /> 'TRE Q Flee.1/95 <br /> Date:—L'._ �6 page--L-of,-e— <br /> t <br />