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• • s <br /> Chain-of Custody Number ' 5 y <br /> SECOR Chain-of Custody Record <br /> Field Office 1 �O Q Additional documents are attached,and are a part of this Record <br /> Address 3f'�`I AkOir. ?QQA !Q4L 100 Job Name — ir a' <br /> 9500 Location a t <br /> Protect# TK1,. }a L a 3Task# a 60 5 Analysis Request <br /> Project Manager <br /> Laboratory Vltl &&6&xACO <br /> C7 0 <br /> Turnaround Time <br /> Samplers Name a n o 'e*a $o d a o o CO C) <br /> Sampler's Signature _ E � m d <br /> 00 � <br /> ✓ Date E— wSam le ID XComments/TiInstructions Z <br /> +►&W� 3v o W- 4 <br /> j <br /> +" 3KUJ_b LA <br /> . S <br /> ./ _ 1011-7 ^1 <br /> r1v�►-6 I to <br /> -7-7 <br /> Special Instructions/Comments Relinquished by f ;Pnnt <br /> d by Sample Receipt <br /> Sign Total no of containers <br /> Print r Chain of custody seals <br /> Company r CO Time a; ,' Date { � f Recd in good conditioNcold <br /> Date Conforms to record <br /> nquished by Received by Client <br /> Sign Sign <br /> l Pnnt Print aA- Client Contact <br /> Company Company �a-- <br /> Ti Date Time-r 2tr Date101703Client Phone <br /> Date (v I I OS Page 3—of l <br />