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• • Chain-of Cu-z"', niirrnh r i <br /> SECOR Chain-of Custody Record 497055 <br /> co Q Additional documents are attached, and are a part of this Record <br /> Field Office -- <br /> 3�� 1�Uy(f Oi+1 ��5 ori Swt 3(a� <br /> Address Job Name <br /> - g 8' <br /> o e o C Location by 0 <br /> � r <br /> Task # Analysis Request <br /> Protect # -TO-710-001-0) ��OZ <br /> Project Manager b"`'� 4 <br /> ;n <br /> Laborator ¢ N1 v?r o o <br /> y N V ca <br /> S O — m <br /> Turnaround Time o -2 �o 0 <br /> irs C3 -0 UU UCL <br /> U <br /> Sampler's Name m 0 E 'No o °>cry o S T m 1 E <br /> Samplers Signature _ e _ o_� "W - a <br /> a = =T s - - _ �, �, ro a `o_.. Comments) z <br /> U 4 O 53 4 6 d QN �4 dN NO o V U <br /> Sample ID Date Time Matrix F—m r-CO F- <c � z cn� n � F r` a`M Instructions <br /> y / Ko <br /> '� V�10 1 0 3 <br /> w--L �lJ I z' 14tH 3 <br /> w -3 Y 1lo tzf3SjHLO <br /> Mw-y IS�Iolaw- 8 H! 1 wgo <br /> �v✓- y ! q o 41-v �/ 3 <br /> Nr�✓-In y I 1'.�5 �� � <br /> Special Instructions/Comments Relinquished by SEObP, Receiv d by Sample Receipt <br /> Sign ,2 — Sign Total no of containers <br /> Print C7&Y -CGl _ Print LI&IN -J Chain of custody seals <br /> Company 5Eccg Company Rec'd in good condition/cold <br /> Time 61' L45 Date f$a Time Date 't Q Conforms to record <br /> Relinquished by Received by <br /> Sign Sign Client <br /> Print Print Client Contact '101DD3ry <br /> I Company Company <br /> Time Date Time Date Client Phone �6 <br /> -7R CuSTREC Rev 7/95 <br /> Date � Ir.27 Page + of <br />