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� 7 <br /> • Chain-of Custody N <br /> SECOR Chain-of Custody Record g(TaIO S.z <br /> Field Office Additional documents are attached, and are a part of this Record <br /> Address Job Name - Ole- <br /> COCK(-v�QO <br /> At[cL,� c.,tou C-A C-r )-1 7V Location elexy — . <br /> ��}} <br /> Project #Ul 1 Task #'N_� Analysis Request <br /> Project Manage ,-,-_ <br /> Laboratory��CL�LUL -E►^ <br /> Turnaround Time (J =Q I " <br /> N UJ � fIJ <br /> --- �°�'G cVl7 OU U `° o <br /> Samplers Name�� CNC)3 r o az o' ao colpo 10 00 °o do a°� <br /> Sampler's Signature a °� 0� o <br /> U °ooN � moov na o a a n <br /> zSam e ID Date Time Matrix 00 1- (0 z� <br /> /t Jr" 30 kA 10 9 O <br /> Special Instructions/Comments Relmqur Sample Rece� t by Received by j <br /> Sig Sign Total no of containers <br /> PrinPrint Chain of custody seals <br /> Comp sc-CG/L Company Rec'd in good condition/cold <br /> Time r" Date Time 4 Date71 Conforms to record <br /> Relinquished by Receive by ClientC�� <br /> Sign Sign <br /> Print_ Print Client Contact <br /> Company Company <br /> Time Date Time$; as Date Cl�entPhone <br /> SEGOp^USTgEG Re 2 49 <br />� Date � I ��I w Page` of <br />