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Chain-of Custody Number <br /> SECOR Chain-of Custody Record <br /> Field Office <br /> QAdditional documents are attached, and are a part of this Record <br /> Address °h 0 P O Job Name <br /> C �► �!`/ Location x <br /> a_0o <br /> Project# 3 -,2g 2Task# Analysis Request <br /> Project Manager '�Pdrr ;0(V_ <br /> 5,L//,.o C ?2 <br /> Laboratory90 <br /> CV <br /> Turnaround Time y v, ro U <br /> 06 m Ca o <br /> ca 0IL <br /> Sampler's Name � � w� a Z � �' �° ° <br /> f- cn �o O� c� �O I� m ar m <br /> co E N v <br /> O N 0 O >N O J N <br /> Sampler's S€gnatur O �� E m CM W _ a. E <br /> o aE; N� 76 _6— <br /> _F0 Comments) <br /> Sample ID Date Time Matrix s �o �m � ¢E �w o c°n w a w �°n a`M P `p Instructions Z <br /> 2� <br /> 3 f� /-Z }� <br /> Special Instructions/Comments I Relinquish by Received by mple Receipt <br /> Sign Total no of containers <br /> r't Print A Print Chain of custody seals <br /> ComV C r "l Time any.. ^ Company Rec'd in good condition/cold <br /> Date Ti Date Conforms to record <br /> Relinquished by Receive <br /> SignSign Client <br /> Print _ PrintClient Contact <br /> Compa Company <br /> T _ Date Time Date 11� Client Phone <br /> secaA CUSTREC Rev V95 <br /> Date .Ll_ 'ZG1�` Page of U <br />