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Chain-of Custody Number <br /> 9 <br /> SECOR Chain-of Custody Record Z(3 <br /> Field Office 0 -77 Additional documents are attached, and are a part of this Record <br /> Address Job Name 7j' ] 1 _ o� <br /> �nciy C® O�r'a �—�►- - c Location <br /> Project#77: di-f7'7 -Tas}c � Analysis Request <br /> Project Managerl��n <br /> Laboratoryo U <br /> N <br /> Turnaround Time ,S CL <br /> Da iL U� o O� m c <br /> Sampler's Nama- a. i'o �°' 0 'a u o cs o <br /> E E 00 '-'CM Ov c- or mom m ay is <br /> Samplers Signature O �� v E oar m �m 7 m �_m J Q <br /> r o a o a °o o N o— ° N" Comments/ <br /> �O C1N 770 <br /> Sample ID Date Time Matrix = Co. m � ¢� >m =2 (Mo a w IL Instructions z <br /> i <br /> Special Instructions/Comments Relinquis y Received by Sample Receipt <br /> Sig Slgn Y -+�-� Total no of containers / <br /> Print Print Chain of custody seals <br /> Company Company 59C Q Rec'd in good condition/cold <br /> Time ate2_ Time. 6,' 3s Date Z17A_Z- Conforms to record <br /> Relinquished Signe rved by� Client <br /> Sign ��, <br /> Print --- Print Client Contact�� <br /> Company Company <br /> Time : 6 Date 1Z a Z Time0120 DateKKM <br /> Client Phone <br /> SECCR CUMEC Rm ZW 1 <br /> Date y l -3 I aZ Page if of 1 <br /> i <br />