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Chain-of Custody Number <br /> SECQR Chain-of Custody Record <br /> Field Office 0_7 Q Additional documents are attached, and are a part of this Record <br /> Address I Z v S r N e--s Mz_ QK , fa] Job Name (+ �1 l <br /> Spa- CA ST91 -7 Location �bb6 7gf>Tot�__ 2/J. <br /> Project # ���'-GIO-0 Task# tZ ° ti Analysis Request <br /> Project Manager LA fS�r+ ko5� Lr <br /> Laboratory scqy Ol*r- T <br /> _ C7 N u Q m <br /> Turnaround Tiime—STP4,1 it 2' 0 - ro^ <br /> 4� z N min (n fly m <br /> z o m� g m <br /> Sampler's Name +^'' '�f^s�rj a s bq 0 % o <br /> o o m ()o po Coo -o n,o ar <br /> Sampler's Signature o v i m m Itl m co a r }` <br /> U ao do a oa ON My �N do It °' v e� Comments/ <br /> Sample 1D Date Time Matrix � r a C _to v)� Q_( F A a f� instructions z <br /> IZ lv WnZEL �'C <br /> u .� <br /> Mu -] I +u <br /> Lr - c( y w p <br /> E <br /> Special lnstructions/Comments Relinq sh y Relinq is ed Sample Receipt <br /> + <br /> 4 I , -IbS L O Att, ,, ff p'Lqo„ Sig ` Sign Total no of containers <br /> Print. V-)�� 0 cr�a�} Print Chain of custody seals <br /> Com an ACL e&t1t=of <br /> p y - Company Recd in good condition/cold <br /> r Time Date 2-40Time IWU Date <br /> Conforms to record <br /> Reliny Rehnqui had b Client �CCV'Z <br /> Sign(!' ?, , �-� Sign <br /> Print olv � Print o�u /� Client Contact .1 17 !�- <br /> Compan S{"�°j°� Company <br /> Time ipso Date z �� Time wSQ Date? �G I_ Client Phone <br /> SECOR Cl7STAEC Rav 7195 <br /> Date Z I i ` I � f Page of <br />