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i Chain-of Custody Number <br /> t <br /> iI <br /> SECQ Chain-of Custody Record <br /> 015- Satre Mcn�p1 �I Additional documents are attached, and are a part of this Record <br /> Field Office <br /> Address 12U 1r,LlE Road, L4- C __-- Job Name C26&co - ST CK%oN <br /> Sc�rarnen�`o, G� 4MS-L- 5'YoY 1' Location <br /> r l�' `Tl6 Lys- 6o F•� 9/6 G�'�- SosB � � � ' <br /> ,E , Analys+s Request <br /> Project # _r roo_-_d�7 oA_ —Task# do <br /> Project Manager J_.A" Qewer .. <br /> Laboratory . 0U,4:A/L(9Qif �� a <br /> Turnaround Time Sf A�Ar� _— a C N in �,cy) <br /> ro > U ro U <br /> im a ? a <br /> Sampler's Name2!-:;U � o�N p o �o 2 0 0) m <br /> Sampler's Signature �/ a ip g,� r N Q E <br /> s A �-4 E y m N o=° -+ Comments/ <br /> U 0. 0. 0. �O ON dN Q� O� d Z <br /> l <br /> Sample ID Date Time Matrix z t-coo 1-coo a I �2 z rn Nn a 8 Instructions <br /> GBi -SS lZ--t3-?1 ,7 Sot /��L0 <br /> '7,'Y" 1{ ffo�0 <br /> C Xt <br /> caf - 7o 9;SG Ik x <br /> (,oD <br /> �e - ao 1i� r� x IP X - <br /> k -,2S <br /> G g - 3SF �� IVOLQ1 IV <br /> Special Instructions/Comments Relinquished� Received by Sample Receipt <br /> Sign it Sign Total no of containers <br /> IRTN� Y 7o Print �� ��e.+�^ Print / Chain of custody seals <br /> C9/G,Cyg_go -A Company^ 11S�fo e Company r�vex _ Recd in good condition/cold <br /> � l Timie _ 3a _ Date 12'z 3'?z Time A Date -Z Conforms to record <br /> Relinquished'by Received b <br /> i Sign 7� i� Client l��✓DG o <br /> Sign <br /> Print l Print 6 FU--)- N"-- - Client Contact 8pw� <br /> ' Company �t Company t� S A <br /> Time <br /> it .f Date Time 1074-) Date Client Phone 671YJ37�-336G <br /> } dIt II <br /> SECOR CUSTREC Rev 1195 <br /> � �, _ Date 1,2 1 -13 Page a of 3 <br />