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Chain-of Custody Number <br /> SECOR Chain-of Custody Record <br /> Field Office <br /> Additional documents are attached, and a.re a part of this Record <br /> �4,T� �r�SSD <br /> AddressZrJob Name <br /> Location '�r <br /> Project #-S(9(3 3 COQ/ —OZ Task# Analysis Request - <br /> Project Manager TI��. c - a r✓ <br /> � r y <br /> Laboratory S c? co <br /> N m C <br /> Turnaround Tim '�; (L W aCDyin TN <br /> 0 as r = O_ N <br /> m m U <br /> co m mN Qo�m Sampler's game o+coo 'oNo o <br /> E m W <br /> Sampler's Signature <br /> 4 E <br /> ll <br /> ❑ 2r =r r oN Comments/ <br /> Sample ID Date Time Matrix s ra-w r°-m a u = cn o a Instructions z <br /> 513-1 S- <br /> 59 -3 <br /> -S --3 ) 1A0 _ 1-Zv-F <br /> S �3 z ✓ I <br /> � _ S_ <br /> SpeciaE Instructions/Comments Relingwshe y Received by Sample Receipt <br /> PSig Sign Total no of containers <br /> Id <br /> Printe,- f Pant Chain of custody seals <br /> E �.^C CompanyO Co ny Rec'd in good condition/cold <br /> 1 <br /> U� t <br /> 11 � �C) Time .. Date 'Z ' tine 0 1, D e Conforms to record <br /> Relinquished by Receive <br /> Sign Sign Client <br /> Print - - Print Client Contact <br /> Compa Company <br /> Ti Date Time Date f Client Phone <br /> SFCOR Cl1STHEC Rev 1135 <br /> .. Date r Z1 Page � of <br />