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oz <br /> • 0 Chain of Custody Number • <br /> SECOR Chain-of Custody Record <br /> Field Office 077 Sacramento E3 Additional documents are attached,and are part of this Record <br /> Address _3017 Kilgore Road,Suite 104 - 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 Kifl`Analytical _ cog <br /> Tumaround Time Standard w <br /> 0 :F ° [ <br /> Samplees Name n ". c W o m <br /> Sampler's Signature em --E m g o N 2 <br /> z z x E g E 9 c a Comments) <br /> Sample I© ate Time Matrix E5 � a m '�L- 2 5110 rs @ Instructions z <br /> MW-1 Water x X X 3 <br /> MW-1A Water x X X 3 7 <br /> MW-2 I kSD6 Water x X X 3 <br /> MW-3 Water x X X 3 <br /> MW-4 11 IS Water x X X u 3 �6 <br /> MW-M Water x X X Sant x a'r Y 3 <br /> MW-5 <br /> CID Water I x X X 3 9 <br /> MW4A 1456 Water x X X 3 <br /> MW-6 ItjIL Water x X X 3 �y <br /> MW-7 4 M Water x X X 3 —to <br /> Special Instructions/Comments Relinqu 40fo WALAIt( Received by Sample Reoei t <br /> 5 Oxygenates.TAME,MtBE,EtBE,TBA, DIPE Sign Sign Total no of containers <br /> Global ID#70607700750(SIRC) Print Print Chain of custody seals <br /> email EDD to cryan@secor.com Company Cam Redd in good cond'dionlcold <br /> email lab report to dherzog@secor com and Time / —Date Time Date Conforms to record <br /> dbrown@secor.co Relinquished by -Received b <br /> Tenet tawnn. Sign Sign Client SECOR <br /> l Print Print Client Contact Damon Brown <br /> � Cam Company ell Client Phone (9161861.0400 <br /> Ceolait pre""t. a Date Time i b G Date—oDate-17-Vog ext~230 <br /> 15ECM CUSTREc ihr zoo n <br /> Date Page Q <br />