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Chain-of Custody Number <br /> SECOR Chain-of Custody Record <br /> Field office rs���`o <br /> Additional documents are attached, and are a part of this Record <br /> _ �Lq' SFI.�l�� �r . .--- + <br /> Address - 3 Job Name //�'f� Cal�, A <br /> 5~81G -700 �location goo a 15, lbw $ <br /> / s �D /o S 9333 e_4 <br /> Od 0 <br /> Project N���..,�� �r Task 4.10e d,A Analysis Request <br /> ProlectManager_ Zkn (3ew4C� <br /> Laboratory r co v <br /> lbrnaround Time _ S"�"n n n r N a c <br /> n. T � m U1 � v► <br /> a o � p0 20 <br /> a Y <br /> Sampler's Name ^ <br /> C21, o <br /> Eo $ 'R d <br /> Sampler's Signature `r o �,�, i3� a E a m p <br /> S a o 1 eg Gammerrtsl z <br /> Sample ID Dale Time Matrix z ►-co co M a z N o a r ti a N Instructions <br /> -At-W r'-1- 'Z� +to r �C Wo x9 <br /> _V1 <br /> 3: <br /> k <br /> 3: 3o <br /> 'ww fill lwArlirthnnslC;nmrnents Relinquished by Received y Sample Reoeipt <br /> I 1 l Sign _ Sign Total no of containers <br /> Print —1� t �✓n Print,/, -r Chain of custody seals <br /> Company � Company 1k x Ge t Recd in good conditionlcold <br /> { /`i, .S G W<2r ��" Time 1C} ,30 _ Date �� Time o')v Date <br /> Gantnrrns to r2oord <br /> ���� c�SG - a!l o Relinquished by Receive Q <br /> Sign Sign Client c <br /> Print Print <br /> Company_ CUe E� �^— Company «t� <br /> Client Contact Sr'K <br /> Time ),DS?.) Date r L Time J/ /.5 Date d`1 , Client Prone <br /> f<< rtrrr m - --- <br /> Date $ Page of <br /> I _ _ <br />