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Chain-of Custody Number 3 47AP <br /> SECOR Chain-of Custody Record <br /> Field Office — O U Additional documents are tattached, and are a part of this Record <br /> Address (7 _ [QC} Job Name 7 54Dre- 3�a'6 " <br /> 7 Location a Vll ( Poll <br /> eAr, <br /> Analysis Request <br /> Project#--7-76&. 3?_ab>>d3rasK#.�f�� ' <br /> Project Manager Zr'%M� �F <br /> LaboratoryW 2 <br /> Turnaround Time -- <br /> if = m he - 9 <br /> 36 0.m6 U o <br /> Sampler's Name o p o r, m a <br /> Sampler's Signature 00 m N b y cy u$ � � m M- m <br /> a a e a E N c Q v Comments/ <br /> Sample ID Date Time Matnx = d m a r-,. a`2 Instructions z <br /> q to <br /> 0 6 15- <br /> tow- 1 Fb I5:33 -� l <br /> f MvJ- q' -[to <br /> i <br /> .r �" t k `��1 <br /> f %d- 6 1-a <br /> VAW- IVICO <br /> V, M�-b O' wi �Eg t <br /> ,� -do <br /> Special Instructs ns/Comments Relinquished by erved by Sample Recei <br /> Sign ' Sign Total no of containers <br /> Pnnt Print Chain of custody seals <br /> Company C Compan Recd in good condrtion/cold <br /> Time Date l 1? Date Conforms to record <br /> R linquished by Received by Client <br /> Sign Sign `�c5 <br /> Pnnt Pnnt Client Contact <br /> Com Company K, a "may <br /> e Date ` Time 112 S Date Client Phone <br /> SEWRCUSTF=wK <br /> Date 1 / 17 /, 03 Page*of <br />� j <br />