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R <br /> ut mk in i by m 5 Chain-of Custody Number: <br /> SECQR chain of Custody Record <br /> Field Office <br /> Additional documents are attached, and are a part of this RA d <br /> �� ' <br /> Address i. Job Name <br /> CA Location j X440 6A5 -///G#WA9' <br /> tpC.KEFcPb GA <br /> Analysis Request <br /> Prosect# '7� �"73 � Task# <br /> Project Manager <br /> co <br /> N yy <br /> Laboratory N C C <br /> Turnaround Time <br /> 06 <br /> M p <br /> Sampler's Name o`" Z, � °" `� ° <br /> 0 o mo 14o mo 'I a� <br /> N V Cr Of+ -20 y <br /> Sampler's Se nature �,� a m� m a <br /> g U S o m a o N o co �o m N m o o N � d U �` Comments/ Z <br /> Sample ID Date Time Matrix = m +O x tO (01° a`O " a i ~ Instructions <br /> vtloo a9M z <br /> MOD wowD <br /> 125# wolnDD�}O <br /> W7 33 0 000041 <br /> ��oo iN0�D00i4�12 <br /> MWS IzS w 0[aDo0�3 <br /> rhWro H <br /> - w aUoo0�i <br /> M W <br /> mwl Aoo W000004 <br /> 7 12 VOMN004 W O U00 4v <br /> Special Instructions/Comments Rehnq a by Received by Sample Recei t <br /> Sign Sign Total no of containers <br /> Pdnt t Pant Chain of custody seals <br /> Company Company Rec'd in good condition/cold <br /> r Time 17 t O Date 61 z a 6 Time Date Conforms to record <br /> Relinquished by Received b Client <br /> Slgn Sign <br /> Pnnt Print 9NAI (Alv Client Contact + KI <br /> Company Compann,v b <br /> Time Date Time I i '� Date 2 00 Client Phone <br /> SECQR CU5TREC Rev?J99 <br /> Date � / � / �0 Page of <br />