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g � a <br /> Cham-of Custody Number- <br /> SECOR Chain-of Custody Record <br /> Field Office 7 C3 Additional documents are attached,and are a part of this Record <br /> Address 4/7 /ZXJ Job Name <br /> Location .tel !L--� � <br /> 9-s6� <br /> 77c-ff.Ck 77�d� e2_5: ► Analysis Request <br /> Project# Task# <br /> Project Manager Ab 6w,,b V�to��_. <br /> Laboratory o v W <br /> Turnaround Time._ -S` .� .. _. i i i g <br /> ter, u 7 m m o <br /> _' <br /> Sampler's Name I's m N o a�o o� m a <br /> Sampler's Signature �, < m m o �. a <br /> C7 =� Sr S E '1� �r ER Flea 3N Q J fy� F <br /> 0 0 o a <br /> -40 CM d o o g �7D U f/V I�S#RtCt Instructions <br /> 7 <br /> Sample l D Time Matrix mm A a �- z <br /> f�" err S <br /> $` <br /> .=" / <br /> Special Instructions/Comments Relinquish Received by Sample Receipt <br /> Sig Sign Total no of containers .3 <br /> Pnnt not Chain of custody seals WA <br /> Company Company Recd on good condition/cold <br /> Time? Datea Time Date Conforms to record <br /> Rel uished by Receiv b Client <br /> Sign Sign <br /> Print— Print Client Contact •• <br /> Company Company cy4gl a# <br /> Time Date Time o b Date - --.o Client Phone <br /> seoORGrsrxEcftv 2M <br /> Date _ / IL L4Y Page / of <br />