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Chain-of Custody Number <br /> SECOR Chain-of Custody Record - <br /> Field Office X70 Additional documents are attached, and are a part of this Re*brd <br /> Address ��1' Ic. lC�,;��';, incl Job Name ,— <br /> _��7� Location - - a `- i-e -I '-{ <br /> Project# '�77.y��� r r�"' Task# Analysis Request <br /> Project Manager ,).,4z t= <br /> Laboratory o 00 U i' LO <br /> Turnaround Time " / <br /> 0� E6 em <br /> 0-0U m o <br /> is c <br /> d 7 N L} <br /> Sampler's Name`�_ �� r o O c ;�o m o c y 0 <br /> N 7 r O�. 00 N <br /> Sampler's Signatur�. =i., ,,�T ��y� E a $ m ME ' o +n a r' <br /> xri x Q rov o - E-a �,� acv `o=° Comments/ <br /> a <br /> 2 �� �$ d �cNo sib J)10 aid �N d2 z <br /> Sample ID Date Time Matrix Instructions <br /> 3_ 1 Zg a It <br /> o <br /> fz <br /> Y I <br /> Special Instructions/Comments Relinquished by Received by „ ,., �� Sample Receipt <br /> Sign Sign �1 ... Total no of containers <br /> Print_ -____ ___ ,^ Print - -',: Chain of custody seals <br /> Company C_ Company --�f Recd in good condition/cold <br /> Time ILDate-1-w-4=0► Tine-" Date Conforms to record <br /> Relinquished by. - Received by f Client <br /> Sign� .�� Sign <br /> Print Z, Print ", .r' •a� r--�' Client Contact <br /> Compaq Company i✓/ C <br /> re6 Date Time t r�� � Date C_ c Client Phone <br /> SECOR CUMEC RAY 299 <br /> Date / / Page_L of Z <br />