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Chain-of Custody Number <br /> SECOR Chain-of Custody Record <br /> 1 0Additional documents are attached, and are a part of this Record <br /> Field Office <br /> Address v-7 <br /> S 6Z0 Job Name <br /> Location <br /> Analysts Request <br /> Project # SCS 3 �O �d Task# <br /> Project Mana er '1-e�i u IL <br /> Laboratory v N <br /> Turnaround Time a z " "�' `° ��' " <br /> O � <br /> ` <br /> m a�, IL <br /> _ o o o Sampler's Name w <br /> m E E <br /> mN mp ]N O J N ` E <br /> Sampler's Signature O_ �'v� °Ln `t E t° CO o m U m yu'" `� a O .. Comments/ <br /> zr -X— S oA _v r Ln am N p'- <br /> d0 a0 d O ON coo dcV 7�0 ov V <br /> Sample ID Date Time Matrix z r CO �03 ¢ _ "' a" �" a` ~ 1� instructions <br /> D <br /> - 12 1'r XXXt l 1 3 <br /> W - -3 19 <br /> n W - L0 <br /> Special Instructions/Comments Relinqui h d by Received by Sample Receipt <br /> Sign -Sign Total no of containers <br /> Print Print Chain of custody seals <br /> Company Co ny Rec'd in good conditionicold <br /> Time 19,1' Date ime Da Conforms to record <br /> Relinquished by Recei by <br /> Client <br /> Sign Sign <br /> Print _ Print Client Contact <br /> Co ny Company <br /> II`r ime Date Time . '�.'s� _ Date 1 b i Client Phone <br /> I Rey 1195 �r <br /> sEcoRcusrREc Date f 1 �-C7 1 '76 Page -?> of <br />