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Chain-of Custody Number: 3 � <br /> SECQR Chain-of Custody Record ' <br /> Field Office: Additional-desuments are attached,and are a part of this Record. <br /> Address: o Job Name: Cvce"CA —/I Ic— <br /> { il C UA�d+la - location: _ �C�.-, _ ,�J�/1 S <br /> Project# Task# Analysis Request <br /> Project Manager 'J 3 <br /> LaboratoryKir f W <br /> Turnaround Time �C"OAo x = <br /> m N 212 m c <br /> f 2XS 6 <br /> Sampler's Name Aa <br /> I .M <br /> e? °po m mo MW Signature g o No <br /> Ega U mo <br /> Sample ID Time Matrix aO <br /> o <br /> U Comments) E <br /> Instructions z <br /> /.' 1W <br /> y <br /> Special Instructions/Comments: Relin Received by: Sample Recei <br /> prt <br /> Sign Sign Total no.of containers: <br /> Print 1. t+�'1 �4cx>,J Print <br /> Chain of custody seals: <br /> Company r CoA, Compan Recd in good condition/cold: <br /> Time�-Date. 3-3o-a� e Date <br /> Conforms to mord: <br /> Relinquished by: Received b <br /> Sign Sig <br /> Client: C'J <br /> Print Print Clien#Contact; �- <br /> n; ._ CompaCompany)Cr� N\NA�`tlT <br /> T Date Time S Dater 3�p y Client Phone: Ul- d�lw <br /> src.cmc ra.2" Z L <br /> Date: 3�3/ " page I of <br />