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Chain-of Custody Number is <br /> SECOR Chain-of Custody Record low <br /> Field Office r 3c Additional documents are attached, and are a part of this ReXrd <br /> Address Job Name <br /> Location <br /> S-Task# Analysis Request <br /> Protect# � � ' �� <br /> Project Manager <br /> Laboratory_k, [I -, Q o m <br /> Turnaround Time & a 8 I <br /> 06 m C <br /> 3:4.. <br /> Samplers Name --, ......_ 0.0" '0 (OL o roa ooo o <br /> Sampler's Signature 0 >>N 3 m <br /> LO Ea s ie i=ie y o o a 'o y Comments/ <br /> Sample ID Date Time Matrix = _in H o a SO 4 ti a � ` �T Instructions z <br /> vw <br /> Special Instructions/Comments Relinquished by j/ Received t Sample Receipt <br /> Sign�.��;,4y, ,s,� , ,,,.TLS I"'H Sign Total no of containers <br /> Print ,,�, IL I_,��, �_� Print Chain of custody seals <br /> Company. -; r y Company w Rec'd in good condition/cold <br /> Time i D%32 Date-J&11- `I-01 Ti —�'�� Date <br /> .�B Conforms to record <br /> Relinquished by, �� Received by Client <br /> Sign Sign--- -/ ;at-: ZZ,�1 <br /> Print Print s Ti T„-r�rnf75E!:!", Client Contact <br /> Compa y Company}. lr=C , 1,,ll.r rd E <br /> Date Time Date**-1 4 01 Client Phone <br /> SECOR CUMEC Rev Z% <br /> Date / "� / Page? of --C. <br />