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• Chain-of Custody Number <br /> SECOR Chain-of Custody Record <br /> Additional documents are attached, and are a part of this Record - <br /> Field Office 541C 041- <br /> Job !Name <br /> Address �J�"��� �� �' L r � - <br /> C - , Location Jf,rc '^ <br /> 64 <br /> Analysis Request <br /> Project# �.3-4 tr) - 0--,-1 ___Task# <br /> Project Mana er, 6Aa rn2 &=g — N <br /> Laboratory ��'LC�% — �N a 0 <br /> Turnaround Time Dft1 Lo M `��' <br /> a� ❑:p =a y 06 m _ U <br /> //�� <br /> Sampler's Name La 1G �o o 0 O c o o v� d <br /> m E E V �� 61N 0F) 1N V O J N Tw <br /> Sampler's Signature_ -� �1-1 ❑ �'to u� E°p o=° co y00 <br /> N o U Comments/ z <br /> U a S a o a E o O N CO o m N a)o o v Instructions <br /> Sample ID Date Timg' Matrix z I- r- ¢ a r. �- <br /> M .0- i !IIx <br /> N.a <br /> r6"V-5 hots , <br /> 76, ,~ K <br /> A Sample Receipt <br /> Special Instructions/Comments Relinquis epi t?y SI- o Received by 1 <br /> Sign _ �1J� _ Sign Total no of containers ;p <br /> Print + Print No 1, L(Ce e r (_ Chain of custody seals <br /> Company_ Sr-40K _ Company PYiiC 0C Rec;d in good condition/cold <br /> Time _,)(Y ' DDate 1011"&13- Time ��` �( Date r' � ' Conforms to record <br /> Relinquished by Received by Client ��:'t�6 — <br /> Sign Sign , <br /> Print Print Client Contact <br /> Company Company <br /> Time Date Time Date Client Phone <br /> SE:COR CUSTREC Rev 1195 ! r r`1 <br /> .� <br /> Date 1 „.- 1 1 ,` Page � of � <br />