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Cham-of Custody Number <br /> J <br /> SECOR. Chain-of Custody Record ( 4 q 5-0,5t ' <br /> Field Office Sca,2 r — s fi���..��,. o �o l�� <br /> Additional documents are attached, and are a part of this Record <br /> Address ! 73�l - 3Y 5 ft 2e�"e Job Name - 7% 7 4/L - - - <br /> .5dLCrdLfA*1+1�1 . - _ - Location `�3y uJe.s-r- ra5cn•;�� ✓e.� <br /> A& ds Cu elL ' <br /> Project S'-60.2^DL_ Task#M4N a Analysis Request <br /> Project Manager I k, Qewer <br /> 9 r <br /> La <br /> Laboratory F-Xc el a k e M c 8 <br /> Turnaround Time cn Cd <br /> a m a00 0 <br /> y <br /> 00 <br /> Sampler's Name o lo�/n H chi o 0 0 ❑ o m o d <br /> Sampler's Signature ❑ �, ,� E o A m CDa� m U <br /> r x '❑ao <br /> E` Comments)Exrx r z(0= co M cSample ID Date Time Matrix Instructions <br /> w1095Dol 3 <br /> w-S I v w�o°�5n <br /> w 3 <br /> w -3 0!5f- <br /> Special <br /> 52Special Instructions/Comments Relinquished by Received by 5a.s Sample Receipt <br /> Sign Sign _ _- Somers Total no of containers <br /> i <br /> Print ,Zz Qrow^ Print Chain of custody seals <br /> Company p-_eje r Company Recd in good condition/cold <br /> Time G QA1 Date AL 9 Time '/Q Date A_-,LIS Conforms to record <br /> Relinquished by Received by <br /> Sign Sign Client <br /> Print Print Client Contact <br /> Company Company <br /> Time Date Time Date Client Phone <br /> SECOR CUSTREC Rev 1195 <br /> Date Page of <br />