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{ Chain-of Custody Number <br /> SECQR II Chain-of Custody,Record ZOO 83 <br /> li <br /> Meld Office _�� i� Additional documents are attached,and are a part of this Record <br /> Address O t �7 i wle- /4 r 'YOU Job Name l�f�/V�Lr �ft/11�F"r <br /> /Qf► t�v C ur[-_7cvf* Com-- Location { Z r6 7 S. -T,41VTA tef Ae/ <br /> Project# 7707 4416 ZZo j Task# 0016 ,N. Analysis Request <br /> Project Manager S r Auc G.f64 L V <br /> Laboratory l�•F� r <br /> 4co <br /> 00 2 y <br /> Turnaround Time�� i m a � N 0 V 18 2002 <br /> O� 2V j o- U c <br /> Z _� o �o m� a NVIr�0i11MENT HEALTH <br /> Samplers Name t MJ C/o � a a - � ca a ' i a' p o M <br /> lr o �o po mo o to A N 9 0 <br /> Sampler's Signature c �.. a v N m o >N °S y m 2 <br /> PERMIT/SERVICES <br /> n ao Ln ac a °o oa �co � mN o ov °c� V Comments/ � <br /> Sam le ID Date Time Matrix a r m �m ►- a m >9 z 8 �Q a m 12 ti <br /> Instructions z <br /> A it <br /> C-fig Q:r� pZ i <br /> j If <br /> I� <br /> f <br /> t <br /> Special Instructions/Comments Relin h Received by Sample Receipt <br /> SEg Sign Total no of containers <br /> Pant ,f k .Sc,r Pnnt Chain of custody seals <br /> CompanyCompan <br /> Time 11 Si Date 4 '27 a2.. T Date Recd+n good condition cold <br /> Conforms to record <br /> Relinquished by Receive b Client <br /> Sign If II Sign <br /> Pnnt Print f1'1t46A^c'k Client Contact <br /> Compan Compan t0' <br /> TiJI3 Date Time 7- 3 Date O 7j-702 Client Phone <br /> secoRcwanEcrte.ZW <br /> Date / 7 / a Z Page f <br /> 1 <br />