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!• tl� � >• tilil� t>, ! � � � � � i• � i>, i 111»1! �E; <br /> Cham-of Custody Number Ilk 5 -3 <br /> SECOR Chain-of Custody Record <br /> Field Office 41- <br /> U Additional documents are attached, and are a part of this Record <br /> Address 2 1-7 A�3"' Qd-sad} IS `�� w Job Name F.nck <br /> Location ;C3'70 <br /> Analysis Request <br /> Project# 0T7.4 .2—M_00"I Task# <br /> Project Manager �p <br /> Laboratory <br /> Tumaround Time v� C_W z �,N g 0 <br /> n <br /> 0o a m VU UU U m 00 <br /> S3 LD <br /> Sampler's Name �" $ 0 o p o m a i o m o m a° m d o <br /> p S E E o my mo oN �o 05 Tw <br /> Sampler's Signature p o,,n v i0 � E m -� o� ' � °°�° � � � LU <br /> V c o a o a 0 0 o c�� � ' �cNv W o v m U Comments/ z <br /> Sample ID Date Time Matrix = m a r a a r- Instructions <br /> 05 <br /> - vg <br /> Special Instructions/Comments Relinquished by Received by - Sample Receit <br /> e <br /> Sao^01� hrn�, a t G JeCt b).^k v Sign Sign Total no of containers <br /> kd J e. b Print e*o� Pnnt - Cham of custody seals <br /> Q^�` � 3'4 t Company 5Q Q91 Company Rec'd in good condition/cold <br /> gg AG6}C1104(- Time 161b—Date V2400 Time Conforms to record <br /> Relinquished b Receive by Client <br /> Sign <br /> tD Qw+.r+o (vrlvy,ti a;r � Signer - <br /> Print Pant a rd� Client Contact ant l <br /> U1.9 ED a rAr D23? Company_ Company 141M .4�►•�wle Client Phone <br /> -CA) Ili FI zi ac05'yI I Time Time Date p 9 z 10 <br /> SECOH Cl15iAEC Hs+?l99 <br /> Date 1 �1 / R Page of � <br />