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0 Chap-of Custody Number <br /> SECOR Chain-of Custody Record <br /> Field Office <br /> C912- SaGrQMe�,+oAdditional documents are attached, and are a part of this Record <br /> Address r�� �aa� *�� C Job Name NOG D ' SroCkroAl <br /> a ra m e +c lof.A 5- / oy Location .25- 6[5 k6 3To ,' - <br /> Pf} r,�/b 6 vd- 9rCo r".�X Cy/J 6Y�- Sos,2 ¢a k�-•� . <br /> Project# Jeyoo- Task #_ Analysis Request <br /> Project Manager r 8 <br /> Laboratory u A1c Q i If 00 ao N 8 � <br /> Turnaround Time _ S_f z o a ^ " e <br /> 1 a n=. U) U) m ro cn m <br /> 2 O� m a <br /> Sampler's Name pp "�^ ° O1`� °T <br /> D>a oo go O mo 'oa �o Ar m <br /> Sampler's Signature "`---- �, >=LO M 0 m� °W i� D o J a <br /> v ax o a o a °o o cap+ go m N d o a ° Comments/ Z <br /> Sample ID Date Time Matrix z i-co i-(0 � ¢R �to i� vs 10 a s 12 r. �M instructions <br /> c B� — yo 1Z z3q 3s Sores #0L_D <br /> z — <br /> 5-0 <br /> C8 .2 --SS 1 1,7,o,;t <br /> cB ;z - t"o /,� ,/o DLA <br /> X <br /> 5 <br /> TP 1,4 1,2 YS x X G Po s r i . rPc <br /> /,7;y s TP 14,S S7-?44 <br /> Srpy,4 %.Vi <br /> /2,1Y9 STPyq rn�o ene . <br /> Si q 4 /Z Y <br /> Special Instructions/Comments Relinquished by Received byi�DEX _ Sample Receipt <br /> r Sign / - Sign Total no of containers <br /> lc'4,y xu75 -s /R,.f /AiGI Y Print Bt-.wn Print P C Chain of custody seals <br /> U Nc J I y go 5 a Company Company r cv Rec'd in good condition/cold <br /> Time 2.' 3" Date 17'23`9.4 Time Datqt 1A"23-gL Conforms to record <br /> Relinquished by Received <br /> Sign Sign Client _(_r�Noc - <br /> Print Print <br /> Client Contact ,11n 60'-f-, <br /> CompanyCompany A " <br /> Time Date Time _JO_3D Date Client Phone(Ay 3-7742 <br /> SECOfi GUS7gEC Rev t195 <br /> Date 3 pPage 3 of 3 <br />