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Chain-of Custody Number <br /> SECOR Chain-of Custody Record p�rc C-71 Iq <br /> Field Office 0-77 0 Additional documents are attached, and are a part of this RArd <br /> Address D/ c) Job Name -77'1_>1C__ / Lam A -�--) <br /> Ge11�o �d a �--t. �?' C� Location / /�... ..,�.C. <br /> Project# O 77, Al) 73 7 mask# Analysis Request <br /> Project Manager- 6:"wrr <br /> Laboratory coi <br /> Turnaround Time .Ga.,��ro� N <br /> 2 a wm�jj su <br /> a p o a °' `-'2 O, m ro o <br /> S � o mC7a ° � 0. 3 " U <br /> Sampler's Name �oa <br /> h0 <br /> �n mao ca a <br /> C o <br /> � 'co co dSampler's Signatur 2v <br /> o <br /> ° z�' z�' = o�, °; E= N `o_�, � Comments/ E <br /> Sample ID Time Matrix = m a m a a`S o o a t a � lnstruct�ons z <br /> 2--A-0 <br /> Special Instructions/Comments Relinquish Received by Sample Receipt <br /> Sign ign;D ,� Total no of containers <br /> �� Y+� vl► P�Int�t��^- Print M%E.LA E Chain of custody seals <br /> Company ��e Company S Rec'd in good condition/cold <br /> �J w Time 6, Date7 c� Time (p . 53 Date b? o Conforms to record <br /> Rellnhed by Receiv Client �r <br /> SignuisSign <br /> Print 1 � OkL. CTL,%,4 _ Pnnib Client Contacted <br /> Company SfiOiZ ___ Company- <br /> Time 1Z ' HD Date a I Time 12 9 D Date 2 Client Phone <br /> 5c — <br /> SECOR CllSTREC Rev 2199 <br /> Date _ � � � ! �6 f Page of � <br />