Laserfiche WebLink
Eiiiiiiiiiiiiii3 ww � E� #� Eiii� Eiiiiii ■�■� � w Eiii� E� � aw �Ei �� �� �w� <br /> Chain-of Custody Number <br /> COR Chain-of <br /> SE Custody Record <br /> Additional documents are attached, and are a part of this Record <br /> Field Office � <br /> cr <br /> Address <br /> 30r7 fly L&0tZC 90110 Job Name k <br /> _ q53� <br /> 2aNr-Nro Ca,T- ;.v 6A Location SAPaTA {'-� (Z„ <br /> Analysis Request -, <br /> Project# 0-7-7 gZ083 006 Task# <br /> Project Manager jArF 0N16 f <br /> Laboratory KIFF ANAL.IDCA I­ <br /> v <br /> Turnaround Time / '' °- a o �F N o <br /> CO ., <br /> ca <br /> I a <br /> 92 LD o C.W CU7 -° (D a <br /> Sampler's Name AV i D 11-40 12- o o `''N p o ca o o o N�'o 0 d a rZ. <br /> �- <br /> Cfl E E �p NN 6f6 ]N O 1 2.0 J Z"ur X E <br /> Sampler's Signature ❑ a'us °u, a E co a o°�Y° w m cv `o `� J Comments/ <br /> Z <br /> U do 0- d °o oN roo �N do `ov U <br /> Sample ID Cate Time Matrix = }-Co. ¢� 'w �� a w a ' w instructions <br /> q 51 ,J I q 5`" 1,.k1 TEL <br /> 3i I av �S Whrl�L <br /> Special Instructions/Comments Relinq he b Receiv Sample Receipt <br /> Sign Sign Zr1 CGc Total no of containers <br /> Print Print + 0vof custody seals <br /> Company f Company�i ' t$Q� �Accl_ - Rec'd in good condition/cold <br /> Time __L)_ST' Date. 5-"'' Time !`I Dat Conforms to record <br /> Relinquished by Received by Client <br /> Sign Sign <br /> Print Print Client Contact <br /> Compan Compa <br /> Ti Date Ti Date Client Phone <br /> SECOR CUSTREC Rev 1195 <br /> Date 0' Page L of f <br /> ,ter <br />