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-0 —0 <br /> Chain-of Custody Nu • <br /> Number <br /> SECOR Chain-of Custody Record <br /> Field Office Additional documents are attached, and are a part of this Record <br /> Address LZ ` Job Name! <br /> Location �vl <br /> Project # Task # L42 L 0 Z f Analysis Request <br /> Project Manager <br /> Laboratory_ .[t✓L r A4 <br /> m � y <br /> Turnaround Time <br /> am <br /> ti Dv —,ry <br /> U�o UUI� c <br /> Sampler's Name a c? _ m <br /> _ �oSampler's Signature m E C o .0CO <br /> � <br /> O n y <br /> Ez OD <br /> U4 o a o ooSam ie ID Date Time Matrix i.—CO co INn 9 r�v `r°d <br /> °emn av I <br /> Comments/ �oEw <br /> Instructions z <br /> L 7L 45 i {. <br /> 3 <br /> T— <br /> I I <br /> � I <br /> Special Instructions/Comments Relinquished b <br /> q Y _ RecervJd by Sample Reser t <br /> Sign Sign Total no of containers <br /> Print - LPrint +u <br /> Chain of custody seals <br /> Company _ Company t -e{ e„� <br /> c_ - Rec d in good condition/cold <br /> Time-JA 4 Date z4-_ Time t Date / -7/fI <br /> Conforms to record <br /> Relinquished by I Received by <br /> Client czv <br /> Sign Sign �� <br /> Print _ Print Client Contact <br /> Company I Company <br /> E�;�.2 <br /> SECOR iIST afr RP 2 <br /> Time Date__— Time Date Client Phone S16 9,6q <br /> Cgq <br /> Date aq 26 La Page Z— of � <br />