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Chain-r)f ri icfnr%t Ni imhor <br /> SECQ� Chain-of Custody Record 1097053 <br /> Additional documents are attached, and are a part of this Record <br /> Field Office <br /> Address �'��� �T �-�- .5T 20 - Job Name Ory <br /> Location Gddc-iybo •• <br /> i <br /> Project#�Q 3'117-0,P I Task # Analysis Request <br /> Project Mana er )y6 <br /> N <br /> Laboratory 0 0c0 N U <br /> N V d G <br /> Turnaround TimeSDrtwO- - o = N M M� <br /> C] c U O 0 U m U <br /> Sampler's Name �� L r o �o m �o o� 0 o �o �o m a° <br /> Sampler's <br /> m OE OE N dV Cr Of� �W M {G A <br /> Sampler's Signature - �0 3 c m J N a- E <br /> U <br /> 0-F) IL ZZ °o oN 00 0i1.J a o oa ° v Commenisl <br /> z <br /> Sample ID Date Tim Matrix z �- �- ¢ (0 _(D N(0 0-to 12 Instructions <br /> A410-- ( l t 'S fes' 3C 1 X, <br /> /W.0- 2 i it 3C x <br /> nit cn7- 0 10 4o 5 )4 3 <br /> h 1;ifs 211m <br /> o K Z <br /> ., 1$*0 1 2103 <br /> 20 <br /> K 5 3 <br /> D W tq 9.ZD <br /> y <br /> Special Instructions/Comments Relinquis e �FLor� Received by Sample Receipt <br /> Sign Sign Total no of containersp <br /> Print Print 0 Q Chain of custody seals <br /> Company_SF_tc>el Company C_ Rec'd in good condition/cold <br /> Time IF. Date 10,L00, <br /> O Time �Cv Date l� Conforms to record <br /> Relinquished by Received by 5 e <br /> Sign Sign Client �...Zvry -- <br /> Print Print Client Contact <br /> Company Company <br /> Time Date Time Date Client Phone o <br /> SECOR CUSTREC Aev 1195 <br /> Date 10 r 3 1. 7Page of Z <br />