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0 0 <br /> Chain-of Custody Number <br /> SECOR Chain-of Custody Record I Z' 15 0 <br /> Field Office <br /> 4�Cw�f'fn Additional documents are attached, and are a part of this Record <br /> ._� , <br /> Address f �`� � 4 lob Name 77 G C- <br /> S1 Location L CI C -�o c� C <br /> PEolect # Nvo .57-.2V1 Task ## Analysis Request <br /> Project Managers2-I-)S--)_— <br /> N <br /> Laboratory _U C, <br /> =N C <br /> Turnaround Trme n t — d o�0 2 N u3 m U7 <br /> 0"o m E6 7 O m ro U <br /> C _ <br /> N <br /> LSI� d� � � � �� � � � O <br /> Sampler's Name 1- o I- o N O c o b m a m CL r m m <br /> 5ampier S Signature p w o CO m o 'w m J y� Q � <br /> T Ln r T T p N ro v N n aP ro N o�° �0€71m8nt51 <br /> Sample ID Date Time Matrix = �m ii-o � ¢a n T_(0 inn a S ,i Instructions z <br /> C, 411 <br /> r <br /> I <br /> Special instructions/Comments RelmquiS �y �L�N Relinquished by Sample Receipt - <br /> Sign Sign Total no of containers <br /> Print _�} . /1�u Print Chain of custody seals <br /> Company Q'Lo^� Company Rec'd in good condition/cold <br /> Time Date the Date Conforms to record <br /> 9 A.CZ4 VZ CK <br /> Relinquis by _ by <br /> Sign "� Sign AM/ Client Sa/P.orJ <br /> el <br /> Print P «rrint Client Contact IL" hmsil) <br /> Compan�'f Company XcO-1 eherI`- <br /> Time `�` Date a Time Date W io t5 Client Phone iu-04'a <br /> SFC6R CUSTACC Rev 91g4 <br /> Date r`L 1 1°[ 1 � � Page_t—of �_ <br />