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Chain-of CustodV Number: <br /> SECOR Chain-of Custody Record <br /> Field Office: UAdditional documents are attached, and area part of this Record. <br /> Address: 173 Y — 3 � _ Job Name:_ ��f d/L //- Loc&-CA14 <br /> Location: <br /> Project#_T 7/0 - po/-b l Task# GG O.t Analysis Request <br /> Project Manager r we"- <br /> Laboratory— <br /> e -Laboratory ^^ o CO e' <br /> Turnaround Time a N o = U3 �,co <br /> o y _� <br /> Sampler's Name � '.," h� E m; mac, o g o �o � " �r m ° <br /> r ` <br /> Sampler's Signature �, 3 m 9 N o <br /> _r z x . Comments/ . <br /> Sample ID Date Time Matrix = o c x w ii; �° a Instructions z <br /> W7�7-5 -16$l !S,•�,� 3 01�. �D So . <br /> u' SS 'sj aLD. 9 <br /> Mt'`' ? 0 1S3 c� <br /> 11-W 7 1114 IQc� <br /> M W 7 vISIS 01-0 S 0 <br /> Special Instructions/Comments: Relinquished b : Receive by: IV dler, Sample Receipt <br /> �d y p AL �ffi`'1PL�s (J/f/�L Sign �,r--� Sign Total no.of containers: <br /> Print Print P%. Chain of custody seals: <br /> Fla%w,�,2 A1071"LF', Company' 5 0 2 Company Recd.In good condition/cold: <br /> Time 6 40 Date T 17•-f! Time Date y tO <br /> ' Conforms to record: <br /> Relinquished by: Received by: Client: rtF �- <br /> Sign Sign <br /> Print Print Client Contact: <br /> Company Company <br /> Time Date Time Date Client Phone: 37 3 <br /> L <br /> SECOR CUSTAEO Aw.1195 - <br /> - Date: IPacr�T. of y <br />