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� l! iitllll>• !• � � i� � � � � f1� i� � i� � � � i♦ <br /> Chain-of Custody Number: <br /> SECOR. Chain-of Custody Record <br /> Field OffiAdditional documents are attached, and are a part of this Record, <br /> ce: � <br /> Address: 0 P P S ✓ 9520 Job Name: <br /> Location: <br /> d � <br /> Project#S`D133 `OnhOL Task# Analysis Request <br /> Project manage r P✓ j P�y�'t�-t q <br /> Laboratory i N V S <br /> Turnaround Time Itze a m i N '�E <br /> rA <br /> CL 2 <br /> U e o <br /> a. Qa ° <br /> o v <br /> Samplers Name�4G/� o O m CO o a m atv <br /> ?� 0 CMOD ' �Sam lers SI nature f <br /> �E <br /> T z <br /> p o <br /> a u)F InstructionsSam le ID s ° <br /> Comrnen <br /> ~2 z ` D <br /> .57 2 <br /> _ 2 <br /> -P f 0 • t <br /> Jfi <br /> Z z- <br /> -2g Fi <br /> Special lnstrudtions/Comments: Relinquishe by: Received by: Sample Receipt <br /> SignSign Total no.of containers: <br /> Printae s Print Chain of custody seals: <br /> Compan SPA)X Company Recd.in good condition/cold: <br /> Time �� Datex" Time Date Conforms to record: <br /> Relinquished by: Received by: <br /> Sign Sign Client: <br /> Print Print Client Contact: <br /> Company Company <br /> Time Date Time Date Client Phone: <br /> S COR CUSTREC R.M5 <br /> Date: 1 �3 1 �� Page—Jof <br />