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Cham of Custody Number • <br /> SECQR Chain-of Custody Record <br /> Field Office 077 Sacramento <br /> Address -3017 Kilgore Road, Suite 100 LI Additional documents are attached, and are part of this Record <br /> Job Name 7-Eleven Store#21756 <br /> Rancho Cordova,CA Location 853 East Yosemite Avenue <br /> Manteca, CA <br /> Project# 77EL 21756 03 Task# 0410 <br /> Protect Manager Jaff Auchterlonie Analysis Request <br /> Laboratory Kiff Anal tical N <br /> CO C* y y <br /> Turnaround Time Standard ¢ ;, a m " L <br /> 1u O r a m V o M c <br /> Sampler's Name Tom Mill ° 0 <br /> e m `� ' " <br /> m � cc a � � m o <br /> Sampler's Signature 0 m „ N T� � � o m <br /> e'a a f0m mw 0) � allo �m o <br /> Sample !D Date Time Matrix MCI Q a o a 2 c o c�i ar p N o qQ Comments/ <br /> ~ ~ ¢ `A `n L' Instructions <br /> MW'* -i�Fater z <br /> tAFa <br /> MWS <br /> I a n / 00 Water x X X <br /> 3 <br /> I F::FF <br /> Special Instructions/Comments Relinquished b 7w— Received b <br /> 5 Oxygenates TAME, MtBE, ELBE,TBA, DIPE Sign y Sample Receipt <br /> Global ID#70607700549(SIRC) print Sign Total no of containers <br /> EDF Deliverables(email EDF to dca#lin@secor coin) Company c Pant Cham of custody seals <br /> – Company Recd in good condat<onlcold <br /> email lab report to dherzo <br /> g@secor coin Time Date Ti Date Conforms to record <br /> Relinquished by —~� Receiv by <br /> Sign Sign Client SECOR <br /> Print Print Client Contact Brian Care <br /> Compa Company t hent Phone (916)861-0400 <br /> Date <br /> STime .Go Date Lo ext 241 <br /> ECpR CUS7REC Rev �— <br /> I <br /> Date Page <br />