Laserfiche WebLink
titi <br /> Chain-of Custody Number: <br /> SECQR Chain-of Custody Record <br /> itl,ona`do'c'u: <br /> 0 -.,4 ments4re''attached, and care a part &this Record. <br /> Field Office: C,4-o 0 <br /> /7 5 1( Job Name:Address: --- <br /> :iCOrn I"PA 4v if Location: <br /> G61 C ke,6, <br /> Project# -r_74e)-hal -0 1 Task# 40.6 Ja Arialysf.s Request <br /> Project-Manager A -99 w <br /> Laboratory <br /> 0A g2n <br /> Turnaround Time— <br /> .9 <br /> CE z v, jF a <br /> iL <br /> OA <br /> g,,�07 Wrn 0Sampler's Name 'sCd 0 010 (D <br /> t.t — .8 CM <br /> Samplers Signature L, V <br /> 0 7:Lo E <br /> E Comments/ <br /> Z. <br /> Sample ID Date Tlme Matrix 9 .0-N Instructions <br /> /41 <br /> w7 IS 7-14- ff-0 4-D 3 0 713 (-o 35 (v V <br /> Iq w7 -,20 I q; 3_5 F)7 <br /> Rw 7- 50 Y, 0 <br /> /Al W7 - qO I q:sna #dItoo <br /> A, <br /> w7 - Vs <br /> M w 7- <br /> Lv.7-Ss <br /> 3 CO-3 1 <br /> m w Iso Ll 3CO V <br /> Mw 7 r'70 15, �v #OLD <�5Mq <br /> Special Instructions/Comments: Re inquished b Receiv d by: t is Sample Receipt <br /> Sign. Sign Total no.of containers: <br /> Print w--4 Print vupp ., Chain of custody seals: <br /> Vk7-AG2 NdZlcz, CQrppany' Company EX�Q <br /> - - " _ C k-a r, \ Recd.in good condition/cold: <br /> Or <br /> Time Date 7- Time I Ul" Date 7-17-4(A Conforms to record: <br /> Relinquished by: Received by: <br /> SignSign Client: .;!,z 45-, ao- <br /> Print Print <br /> Client Contact: 1717"1 40 w.? <br /> Compan< Company. <br /> Time Date Time Date Plient Phone:7-1 <br /> E CU TRE A.1/95 <br /> 7 <br /> Date: Page 3 of <br />