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p✓1/v+. / w �. <br /> Cham-of Custod er <br /> t2 CC �R Chain-of Custody Record --} <br /> Feld Office Additional documents are attachled, and are a pa of this Record <br /> Address t� 1 -- Job Name L- <br /> Locat:on �. <br /> Protect# W7,L4 i 11'71-WI Task# Analysis Request <br /> Protect Mana er ►'\ <br /> Laboratory �1 <br /> H <br /> Q r U V <br /> J ! <br /> Turnaround Timem x N v, �, R U) t� <br /> w :L o CU <br /> Sampler's Name + a o a`00 o o fl a v <br /> Sampler's Signature R �, E m °'co u� m EDID E <br /> U 0.o as a °o oN �o a)N mo ov °' C) Comments/ � <br /> Sample ID Date Time Matrix = m Q i N a �- a Instructions <br /> Z~R-M 77 0 W! ID _q, o o Ll 3 ' rk ` MAcs 3 <br /> X e_ fv <br /> �u <br /> UJ <br /> � o I <br /> fA2 <br /> 06 <br /> Special Instructions/Comments RelEnqA <br /> ed by Received r !�Q Sample Receipt <br /> Sign ^ Zn Total no of containers <br /> Print 6 vAl,) ,J 4, Print Chain of custody seals <br /> Company -)ELOR w N ip-- Company C Rec'd in good condition/cold <br /> Time VDate 3 Time.& Date q-'3 2_a Conforms to record <br /> Relinquished by Received by Client <br /> Sign - Sign <br /> Print Print Client Contact � �n <br /> Company _ Company <br /> Time Date Time Date Client Phone <br /> SECOR CUSrREC Rev 2199 <br /> Date Z_ / l / Q Page of <br />