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I� JI <br /> J� <br /> I � , <br /> I_ <br /> r ! f <br /> Chain-of Custod l Number <br /> SE coR Chain-off Custody Record Z3 <br /> q _ <br /> Field Office 4? Sa(-'-a ,n+0 E Additional documents are attached, and are a part of this Record <br /> Address 30l til ar-2 S.,► UUi IE Job Name Mar , - <br /> Rar.cln� Cordova Gf4 S67 ,F Location P-0- �d <br /> r <br /> G <br /> Project# d1 43 6 Z Z Task# d Analysis Request - <br /> Project Manager,uF* Aruc.h ter(o�` f <br /> Laboratory )Ci X ria l ;Ga I I`f <br /> i V 0 <br /> � <br /> Turnaround Time Do. a e� %Qx o LMM N �� N <br /> a00 <br /> U U U S O <br /> Sampler's Name E t a Gare F �, ri o o �, n o °^'N � <br /> 0 0 <br /> Sampler's Signature —� I E t0 0 0 N o m = r-N �1 o <br /> � V 6. 0.O E� �v �� E� N� �N S 0. 0 �oa i' <br /> Sample ID Date Time Matrix �i x m X$ c m a. a` N Comments/ <br /> Instructions Z <br /> ' 11 If <br /> 'I 'll II <br /> a <br /> Special Instructions/Comments Relin shed by Received by Sample Rel t <br /> p�cy o�nU}-e5 <br /> hi-RE tg Signal Sign Total no of containers <br /> fl1P�, Ti4 M L Prind r-1 a Print <br /> Chain of custody seals <br /> Company II S SCAR <br /> Comp Recd in good condition/coid <br /> {Timet Q'` Q Date 1 e Date <br /> Conforms to record <br /> Relinquished by Rec i d Client <br /> Sign Sign <br /> Print I4 Print NN �"� Client Contact <br /> Co y 1! Company t = ANNA- <br /> me <br /> �N 1� <br /> 11 me''l �l Date Time iOXSDate 110l`,01 Client Phone <br /> sEGOR clisMec R,1 � � <br /> Date —A2—/--S- / Ul page f <br /> 1 <br />