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Chain-of Custody Number <br /> SECOR Chain-of Custody Record <br /> Field Office <br /> Additional documents are attached, and are a part of this Record <br /> Address 0z-i Job Name 7 G d 0 <br /> Z Location D <br /> QoPt <br /> Project#71M98 -0/D"03Task# Analysis Request <br /> Project Manager 1r ��,•i/ _ <br /> Laboratory 52C C2 �, <br /> Turnaround Time 1� z cn ,� a 6 <br /> LU m io U v <br /> 06 (mj 3 v, �j <br /> El 0 <br /> Sampler's Name ���� �0 0.o m o p o in o ro o o b o <br /> m m a�- w <br /> Sampler's Signature - E a = Q N I b °N o <br /> _� =r z o 10 4 °-E E� N� �N d�° a Comments/ <br /> Sample ID Date Time Matrix x �m m ¢` > _ r°i a � a` Instructions z <br /> w_ =3 6 ' g3/ X <br /> r I r <br /> A W- �(— � v/L'� <br /> :5'—1 1a;4/5 <br /> S <br /> 5 '3 oya <br /> S1171 <br /> r <br /> Special Instructions Comments Relinquis by Rec ed y Sample Receipt <br /> Sign Total no of containers <br /> G�-:,�� , c..� <br /> Print Print Cham of custody seats <br /> Company Company 30001H Recd in good condition/cold <br /> Time 1 _ Date !"Zf Time LAO:_ `Date Conforms to record <br /> /�* /"�� �k}�3`� r�r>✓S oda �riyi�fL Relin s d Recei <br /> Sign Sign by Client <br /> o /44 A/ 9,Y F46 D Print OGS ( Print oW (( <br /> Client Contact <br /> Company S Prs(,lorr! Company <br /> Time /�((O Date 7-1Time / qqP Date Tzl h7f Client Phone <br /> SECOR CUSiREC Rev 1145 <br /> Date / Page /of <br />