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• Chain-of Custody Number: 0 <br /> SECQR Chain-of Custody Record 2 6 `? 3 0 <br /> Feld Office D7 Sa <br /> 7 c.rwr AiO _ 0 Additional documents are attached,and are a part of this Record <br /> .,_ <br /> Address w01 f R a S e- 100 Job Name R4ftch Aa tka,+d — <br /> F-e�+cl.e Cordc [,A- g Sfi7a Location �3stq So h Saha 2a-- -- <br /> R i ver a+t C. <br /> Project#-n 61`.4'3(17.da o02 Task# Analysis Request <br /> Project Man ed-0- lic-M-4 r Io r i 2 <br /> Laboratoryr�1 f►r-� � s" <br /> Turnaround Time <br /> Y o o �� <br /> x05i 4 <br /> Sampler's Name o o o o 26 i "a( o <br /> Sampler's Signature Em S k�IS n 1P is <br /> U = a o a o t+� o n'�i m p g ' U t) i Comments/ <br /> Sam le ID Date Trus Matnx = m z m r^ W Instructions Z <br /> QW L 5t w-er <br /> Special Instructions/Comments Relin uished by Received by. Sample Receipt <br /> S` Owner.a ids" N►t$Ez jrfi,gq -mMj_r Sign Sign Total no of containers <br /> T�A Print '¢ Print Chain of custody seals <br /> 1 Comp ny �0" Company Rec'd in good condition/cold <br /> 106k :r.Q Time ,W Date "` Z- Time Date Conforms to record <br /> to6moo477 Relinquished by Receive y Client <br /> yQIF& %1d1"Pe # Sl RG Sign Sign <br /> Print Print ofd/cf*' w if A- Client Contact <br /> Company Company k; <br /> Time Date Time/ 'Lo_ Date�2 Client Phone <br /> � <br /> 8Econcu3rMcR.r tiea /� L,/ <br /> ] Date V � f � a Z Page_....of <br /> I <br />