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y <br /> 9 <br /> Chain-of Custody Number <br /> SECOR Chain-of Custody Record <br /> UAdditional documents are attached, and are a part of this Record <br /> Field Office --V _ <br /> Address OCA Job Name <br /> " ' <br /> Location <br /> Analysis Request <br /> Project#J0 3AO- Od 1 Task# 1 <br /> Project Mana erg)o&.i lin..}:,0 N <br /> N N <br /> Laboratory N <br /> Turnaround Time a m CL S? ca 22 N o <br /> Ou Uro N U <br /> `DC7 as o <br /> C7 n a <br /> a - <br /> Sampler's Name m E E a o O N ami o ?N o C13 2 <br /> a L, E <br /> CL <br /> Samplers Signature a i LO :J:r = o CO CO m m E LO m CO v o Comments/ z <br /> Sample ID Date Time Matrix <br /> = �C �C <(0 �o _(o (nn a..0 �� �g Instructions <br /> lww— to CV f l o= tj 3C 3 <br /> Special Instructions/Comments Relinquis b Sr COA. Recei d by Sample Receipt <br /> Sign Sign Total no of contamers <br /> Print n, Print rG�� C 2 Chain o4 custody seals <br /> Company -5 --( Company C Rec'd in good condition/cold <br /> Time lc __ Date cglisLh Time Date 10 !3 Conforms to record <br /> Relinquished by Received by <br /> Sign Sign Client <br /> Print Print Client Contact <br /> Company Company <br /> Time Date Time Date Client Phone 6(030. Mon <br /> $ECOR CUSTREC Rev 1195 <br /> Date CQ f3 page 2 of.�_ <br />