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rr ■r r �■r � � 3 <br /> Chain-o# CustodyNumber /W <br /> SECOR Chain-of Custody Record <br /> o�� f` 0 Additional documents are attached, and are a part of this Record <br /> Feld Office � � <br /> Address Aja k} L au� ��• t l0a Job Name M kL� <br /> Location �� S, Sw. � <br /> 6,. U gS <br /> Analysts Request <br /> Project#_?7. V)L ooa Task# <br /> Project manager OL IV <br /> N A m <br /> Laboratory F =o m <br /> Tumaround Time ,Aj Q _ OF m '22 0 010 <br /> Sampler's Name `'L o o �, o N o o o v a <br /> Sampler's Signature E `° 2 N m o ° x m g �^ <br /> z m s r s o a °m E�, �, is- Comments/ <br /> U ao a-C:) a oc� �o mcv my m U Q <br /> Sample ID Date Time Matrix x u, f-m r a r w CO m 0.m ti CL Instructions <br /> 13 <br /> ao Al <br /> Special Instructions/Comments Relinquished by e— ta Received by Sample Receip <br /> t <br /> Sjgn��.,.�.�1. l Sign <br /> Total no of containers <br /> +i,f- c,,.` 1 e-F+ 61-n k Print C Print Chain of custody seals <br /> W. �� L, Company Cd Company Recd in good conddion/cold <br /> Time Date Time Date Conforms to record <br /> Relinquished by Received by A Client Fil, 4bn� <br /> p - sign <br /> Ids fie �a�F �M�h�ar�a�� Sign 9 !' I? /, r i Client Contact <br /> A„t �sM Print Print. <br /> a,b� S;c.0R A," Company Company rvr c- <br /> F�, 916 -3(,l Time Date Time °� Date C 22 as Client Phone A�1���1�� ' � <br /> SECOA«,sic R,PM <br /> Date _ / a# / �0 Page of �. <br />