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S � <br /> Cham-of Custody Number <br /> SECOR Chain-of Custody Record 12 jjo 05111 <br /> Field Office (�!_ _ 0 Additionado uments are attached, and are a part of this PBtt�prd <br /> Address 3y 17 1Z 60izr IZV o U Job Name 1 <br /> zGb64"N.— Location <br /> Project#07 -7- 1-10 31 ouz-Task # Analysis Request <br /> Project Manager_ -7 cl M2�wJ <br /> Laboratory. LVC-CL e <br /> 0 0 °� N V <br /> Turnaround Time ST A�0lljf0 =oC <br /> 0. N V) 6 01N U <br /> IL <br /> �`�- •J / C/`�p�f?ruJ ❑ mUrnJ U W ¢U N C O a y r4o F� <br /> 0 <br /> 0Sampler's Name <br /> Sampler's Signature m aE E2 0012 �oU <br /> = p i� EawCa a (0 <br /> Sample ID Date Time Matrix lfD n� o 1 Instructions z <br /> flu - Alt k Pr0�5041� Z <br /> Special Instructions/Comments Relin s bu4i Received by Sam le Recei t <br /> Si a Sign Total no of containers <br /> Print _ 1 !��� JE1�30-1 Print Chain of custody seals <br /> Company Sccu'Z Company Rec'd in good condition/cold <br /> Time 3 Date ►U s� Time Date <br /> Conforms to retard <br /> Relinquished by Received b Client 'to <br /> Sign Sign <br /> Print Print Client Contact tai �1rLow�+ <br /> Company Company ^ L I -G Lf UU <br /> Time Date Time Date Client Phone <br /> SECOR CUSTREC R-2/99 <br /> Date `U / / Page—I of -L <br />