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Chain-of Custody Number: <br /> SECQR Chain-of Custody Record . <br /> Field Office: Additional documents are attached, and area part of this Record. <br /> OIL— <br /> Address: 173 y 3 -07 _ Job Name: I <br /> J� 14 Location: _ l Ya.co If, lywr <br /> ley cke <br /> eif <br /> Project# la'&Q -aa f - Of Task# 406 6 o¢ Analysis Request <br /> Project-Manage, v�c.� <br /> Laboratory �^ o CO, m <br /> Turnaround Time x N C <br /> ,( 0 <br /> Sampler's Name • �f's1.1A r� � m, �o 'o �o .5018 <br /> 19 <br /> Sampler's Signature G In & m m g a . E <br /> Up = E Comments/ z <br /> Sample ID Date Time Matrix = $ a. m s 8 rg's r r` a 2F- Instructions <br /> fff 14 3L4 F1 <br /> MWG - 70 :30 11vL0 <br /> l�liJ4 757' 9:3 NaLQ <br /> /1 W 6- SO qO qq <br /> MW aL 3` <br /> 1ld11 <br /> W 6 751� ;�� lf6�.0 <br /> 7 —j 1 q,,,2 0 ffoLO <br /> Mw -7 —10 qusa oL0 p lv <br /> Special Instructions/Comments: Relinquished b� Received by: Sample Receipt <br /> UholrlL Sign.— Sign Total no.of containers <br /> Print Print XChain'of custody seals <br /> Company Company VV\ Rec'd.In good condition/cold: <br /> Time Date /7-Pt Time 12trSO Date!--L1::qb Conforms to record: <br /> Relinquished by: Received by: <br /> r Sign Sign Client: G- <br /> Print Print <br /> Client Contact: --Aa l�k/= <br /> Company Company <br /> TimeDate Time Date Client Phone:7�y <br /> hOOR 7R w tips , <br /> Date: 7 11.6 1 7.� pang sof�. <br />