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Cham-of <br /> Custody Number: 2_754el <br /> SECOR Chain-of Custody Record <br /> Field Office crawWA+C7 0 Additional documents are attached, and are a part of this Record <br /> Address3017Y--')Wow— 9A S too Job Name RrC.k /10'f4i- <br /> nc G Location 2.3 V q So PU Fe RA <br /> R;y+er 6iAt <br /> Project# ot: OI Task# OOoZ. Analysis Request <br /> Project Manager v 1 i L <br /> Laboratoryg I C <br /> Turnaround Time t D Aa S a <br /> 06 m c <br /> 3 <br /> Sampler's Name ia,n G ctre a ,�? i � 9 0� � c6 <br /> qt <br /> Sampler's Signature € � N m g� o ' c <br /> Sample ID Date Tme Matrix rall � ° a a Instructions <br /> t&KC-) 7/4-2 tgao <br /> i S�Z �4rg �bztBQs Sa;I 2. _oz <br /> i <br /> Special Instructions/Comments Relin shed by Received by Sample Receipt <br /> Co^VkfesS s$1" 54I'$, �P ^C Sign Sign Total no of containers <br /> 1f1to oi11Q "osi(e c4v#aCPL( Print 04'. Print <br /> ff �� Chain of custody seals <br /> (.C1�h>41f�e S Sf A 4- SPS^ 1 Afo TimeComp6 s— a 1 rsZ Come y Recd in good condition/cold <br /> (fig l--�-�_Date Time Date <br /> Coir�psi}�- Sa� Ste"' 7r Relinquished by Received by Conforms to record <br /> Client <br /> 6[o6l i't> 'Ta 6C0700477 Sign Sign <br /> W14 d valve S1 R G Print Pnnt Client Contact <br /> Compan Company ' <br /> SWW«, Time Date TimahL.S_ �.Dated 71Q Q 7- Client Phone- <br /> - Time—.. <br /> t <br /> Date S /OZ Page of <br />