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Cham-of Custody Number . - <br /> SECOR Chain-of Custody Record <br /> Additional documents are attached, and are a part of this Record , <br /> Feld Office sr��� <br /> Job Name c0 <br /> Address C Location qc) W�� c�� w <br /> b ��`bc K�n CA- <br /> Analysis Request <br /> Project# off- Task# c-o <br /> Project Manager_aUhn h02V <br /> yyr '/ <br /> Laboratory m C d �- <br /> Turnaround Time a C0 x m o �' m" 96 f L c; <br /> 4Ae <br /> Sampler's Name Clf " a E �' "N o m a >N o 3 N 5 E <br /> o <br /> o.. z <br /> Sampler's Signature n 2:Ln z r o a a ° y a ` d ionrills/ <br /> CL ro o a 00 o v Instructions <br /> Sample !D Date Time Matrix z m a x co a0 co 0-w �- <br /> 714qF 4/2-1 N?o+� Lr j <br /> HIT <br /> Relrn ui �,ed by [o Received Sample Receipt <br /> Special Instructions/Comments Sign q y� _ Sign Total no of containers Z <br /> Print "� �Irr Print <br /> Cham of custody seats <br /> Company 01�. _— Company Redd in good condition/cold <br /> Time 15'?S Date -2 Time f st t5 Date± l-11 q Conforms to record <br /> Relinquished by Received by <br /> Client .5C-Cor, <br /> Sign Sign -�— <br /> Print Print Client Contact 102 <br /> Company Company <br /> Time Date Time Date Client Phone <br /> SECOR CUSTREC Rev 05 <br /> Date ill 1 1 7 Page_..L-of <br />