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71Z <br /> Chain-of Custody Number: <br /> SECOR Chain-of Custody Record <br /> 7 Ca 1 <br /> Field Office: c'sco Additional documents are attached,and are a part of this Record. <br /> Address: _ L Id jy ff S a� Job Name: -P-67R ELe- -, e - <br /> /_,i�-A. GSI S�f 9' Location: 1Y2 f Fl-e-�, e 4 <br /> Project#6.5 i_ L5'03Sl,0 a Task# Analysis Request <br /> Project Manage rl?'�+�t'� 0 Ca on ,u 4 i <br /> Laboratory S 7"C, 7 <br /> Tri `� <br /> Turnaround Time -`{_11?r f i� ¢m x y 6 L; e <br /> O T L c <br /> � -- � v Ta n aU v (�IQ y y � � O <br /> Sampler's Namey•A�J !?ta a 21ca 417 <br /> Ci maE �9 d N r <br /> Sampler's Si natur C (M4s� 2o dn� jo �'n <br /> Z _ ��Sf]'Y <br /> EE Comments/� O c+� m G ba7h Sample ID fate Tme i Matrix =o <br /> Instructions <br /> l f-3 ` a- L a a a S D _J— —� 1 H <br /> wl -3 ' l n.S IN <br /> 44 <br /> tl ! -3 y �i � f Na 1 l ° <br /> NO 64 L N <br /> i<s - 0 <br /> j <br /> T f—�8 ,s3� ! a <br /> i <br /> I <br /> Special Instructions/Comments: Relinquis by: Received b : f - Sample Receipt <br /> Si Sign y Total no.of containers: <br /> Print 141" 4 ice,w Print_ t_� ���f Chain of custody seals: <br /> Company SF P Company 5 ( > , Rec'd in good condition/cold: '" <br /> Time 2 0 Date 2-11'� Time71,�y Date - Conforms to record: <br /> ' '' g "'1 Relinquished by: Received by: <br /> Sign Sign Client: <br /> Print Print Client Contact: — <br /> Company Company _ <br /> Time Date Time Date Client Phone: <br /> Date: f C1 Page of J_ <br /> J J J a J J l l 1 l <br />