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Cham of Custody Number <br /> SECOR Chain-o# Custody Record <br /> Field Office 077 Sacramento Q Additional documents are attached, and are part of this Record <br /> Address 3017 Kilgore Road,Suite 100 Job Name 7-Eleven Store#19976 <br /> Rancho Cordova,CA Location 1399 North Main Street <br /> Manteca,CA <br /> Project# 77EL 19976 05 Task# 0410 Analysis Request <br /> Project Manager Damon Brown <br /> Laboratory Kiff Analytical W a 8 iA <br /> Turnaround Time Standard a wo v, <br /> „ so > o <br /> Sampler's Name Co e � w <br /> Samplers Signature E = N o 3 of <br /> o m m <br /> p g Q =r x E W N g�_ iK 4 Comments) a <br /> — � � o <br /> Sample ID Date Time Matrix i � F °' a` . : _ m O w Instructions z' <br /> MW-1 { Water x X X 3 0 <br /> f MW-1A Water x X X 3 oZ <br /> MW-2 Water x X X 3 63 <br /> MW-3 Water x X X 3 fly' <br /> N <br /> MW-4A Water x X X � 10iQ Y f Qli#�i rM, 3 D B <br /> MW-5 Water x X X 3 <br /> MW-BA L5( Water x X I X Therm.IC# 3 7 <br /> MW-6 « Water x X X rNtls 3 <br /> MW-7 �� water x X x ant as No 3 tiq <br /> Special Instructions/Comments Relin s d by Received by Sample Receipt <br /> S Oxygenates:TAME,MtBE,EtBE,TBA,DIPE Sig Sign Total no of containers <br /> Global ID#1'0607700750(SIRC) Print 10, Print Chain of custody seals <br /> email EDD to cryan@secor cam Company CompanyRecd in good conditionloold <br /> email lab report to dherzog@secor corn and Time Date % Ti Dat Conforms to record <br /> dbrown a@secor cam Relinquished by Received byAl <br /> Sign Sign Client SECOR <br /> Print Print Client Contact Damon Brown <br /> Comp Company i t ck Client Phone (916)8614400 <br /> Date Time _Dated c ext.230 <br /> SEa*UXTREc R w WN <br /> Date ti {Z Page <br />