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i <br /> Chain of Custody Number: <br /> SECOR Chain-of Custody Record <br /> Field Office: O11 D Additional documents are attached, and are a part of this Rekord. <br /> Address: Q a Job Name: Q4U <br /> J A C, Location: L <br /> Analysis Request <br /> Project# VI .4 ISS I. tx�1 Task# <br /> Project Manager R V <br /> Laboratory I <br /> Turnaround Tune z <br /> D� ca$ O� m c <br /> 'id <br /> Sampler's Name a ai o p o o n 1111.10 o`3 m o <br /> Sampler's Signature m N v `� °~ a V <br /> O a �� do ow �o EN mo ov "� V Comments/ <br /> Sam le ID Date Time Matrix z ►- ¢m >+o x ro r�i a rn 0 ti a Instruction <br /> Special Instructions/Comments: Rel"' . Received b • Sam le Recei t <br /> Sig Total nc.of containers: <br /> PrinPrint Chain of custody seals: <br /> Compan _ E G Company ` f�ec'd in good condition/cold: <br /> Time —Date 1 Time 2-.'9_T' Date Conforms to record: <br /> V <br /> Relinquished by Roce'i�d by: Client; <br /> Sign Sign �_ <br /> Print L-C1I a;;;L Print kV e r. vt' krkl[, <br /> ,6,)v Client Contact: Cvc�R. <br /> Company Company •£ AA <br /> Time Date Time 1600 Date OT t Client Rhone: <br /> sEcoa cuSrW ate,v9s <br /> Date: Page_.L of <br />