Laserfiche WebLink
iI1 I I II <br /> I I i <br /> I I <br /> i Chain-of Custody,Number 313 Z <br /> SECOR Chain-of Custody Record <br /> Field Office a II i U Additional documents are attached, and are a part of this Record <br /> Address 177 1�w !o 11 <br /> 6 II ,fob Name a�+c <br /> 7� <br /> I <br /> Location <br /> I� <br /> Protect# '77oT' Task# !I Analysis Request <br /> Project Manage . Z <br /> Laboratory <br /> Turnaround Time 9 L� <br /> Sampler's Name RRx� ' � 20 ' 0 <br /> �> h-I$ £ �o pa at0 �o �y°v p <br /> Sampler's Signature o � LL' a $ M N is's ;N 0 1 W <br /> _� x r � S. "a 00 m Comments/ <br /> -Sample 1D Time FY <br /> x �m �m � d�$ �o =w �o a w ►-� a� � instructions z <br /> I II <br /> h 'I II <br /> I! !I <br /> Special Instructions/Comments Relinqulsi Received by Sample Receipt <br /> Sig Sign 9 Total ria of containers <br /> Print <br /> � Company �� Com Cham of custody seals <br /> Time �l �� Dat a ep Date Ree'd in good condition/cold <br /> Conforms to record <br /> Relinquishetl by Receiv <br /> Sign i' Sign y <br /> 9 Client <br /> Print Printt t W Client Contact r�� <br /> Company Company 1�:f <br /> Tim �l Date Time 118Date_ Client Phone —lO� <br /> > �� <br /> Date `2­1 / Page 1A <br />