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� I <br /> Chale_of Custody Number: � <br /> SECOR Chain-of Custody Record <br /> Field Office: <br /> d1-'` Additional documents are attached,and are a part of this Re&rd. <br /> rtcon <br /> (1 E _ , <br /> Address: Q a Job Name: Q14A <br /> A, Location: Ls✓vL <br /> I <br /> Project#0M•4A14►g J . t>7 Task# Analysis Request <br /> y <br /> Project Manager r <br /> Laboratory + I V m <br /> Turnaround Time R— to <br /> _ <br /> �a 0. m o2 4 pM m c c <br /> Sf R <br /> so 2U'V n U <br /> Sampler's Name *� a-5y O19 0 <br /> i m 20 po mo `0 mo q Q°,y <br /> o m ° <br /> Sampler's Signature o m m ohm 'co -m m a °' <br /> _ __ a <br /> U aa.. a o d °o o c� *�o f`° ayi o a a '� ° U Comments/ 3 <br /> Sam ie I D Date Time Matrix z r r m r ¢`a x r�j a 0 r Q r Instruction z <br /> i <br /> i <br /> Special Instructions/Comments- Relinq ' Received b Sample Receipt <br /> Slg Total no.of containers: <br /> Prin %r'A Print e� Chain of custody seals: <br /> Company Company Rec'd in good condition/cold: <br /> Time–Lia—Date Time Z:SS Date Conforms to record: <br /> v, n <br /> Relinquished b Receiygd by: Client: -01 <br /> Sign Sign lC.�„� <br /> Print LTJ La PrintRV .fk P,�Ny Client Contact: CvG�R� <br /> Company Company Few <br /> Time�j�Date � Time ['600 Date t Client Phone: <br /> Date: _ _ / 1� / Page of <br />