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0 0 Chain-of Custody Number <br /> SECOR Chain-of Custody Record <br /> Field Office <br /> t en.koAdditional documents are attached, and are a part of this Record <br /> Address M7 �4Sw - 6 Job Name gfQk4_GO — 5 Toy �%o Al _ <br /> Location `J 3.?S C=wsfi Ski ' a S ire tf <br /> PR= 916 b48-716o F4X,- 16 6119^805 Sf0-JP. e <br /> lf <br /> Project# �P_o - O II-6oR Task# a Sr Analysis Request <br /> Project Manager a ewer <br /> Laboratory q_UAA1 -ek.R/f o o �, <br /> Turnaround Time y NCa <br /> OV0115 o <br /> / D a= o <br /> ca m 00 a. m t U <br /> Sampler's Name zzo <br /> or: r > �s n o' c o <br /> co �N 00 c0 20 no M 2:z m op <br /> Samplers Signature o ,� a "m �,� I C a <br /> v a o °d a.o d— a QonU z <br /> e Time Sample ID Datn to d! . <br /> Instructions <br /> G 9 1 -- S 30; 1 �oL <br /> I -f0 8 .3 Ho L- D <br /> )( <br /> c- I -d?D $,'�,Z 17oL � <br /> ; '{Q Alo L p <br /> GBI - 3c> g ;S <br /> I -3s ;�s /Q� p <br /> Coll 9r1� WOLQ <br /> ffv L jo <br /> CB -f8 id I X <br /> Special Instructions/Comments Relinquished by la Received by . i���"X Sample Receipt <br /> �/{X RESucTs JMMEDIATEL r � Sign Sign Total no of containers <br /> l O Print _ %.�.� (3f.,�n Print Cham of custody seals <br /> �.ld B►oW� ��9/� 6Y8- 8osa Company Seco 2 _ Com an � �= CX <br /> p Y— Rec'd in good condition/cold <br /> Time _/8 .Vo Date/Z-2;-?,C Time 1 0 Dat z-Z1' l Conforms to record <br /> Relinquished by Receive <br /> Sign Sign Client CONOG o <br /> Print Print _!!� FtE) n6z <br /> S Client Contact <br /> Company Company �fa�� Bew.er <br /> Time Date Time jam — Date J Client Phone 7111 3 33 <br /> SECOR CUSTREC Rev IM <br /> Date IoZ 93 i% Page of 3 <br />