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Chain-of Custody Number <br /> SECOR Chain-of Custody Record Lq°16b°L <br /> Additional documents are attached, and are ecoid <br /> Field Office 07 <br /> Address <br /> �vz �-Ers Qr�•r - /JC - .w Job Name Q 1L L "c z� ecu o <br /> Location /Y,Ocrd <br /> Analysis equest <br /> Project#, 73 7 Task # <br /> Protect Manager�C� <br /> cCL �L. w L <br /> LaboratoryCM <br /> L X c ca o m 4 <br /> Turnaround TiS�/1rr O�c� cn <br /> me a 5 a o N ' <br /> m Z, o <br /> Sampler's Name !-►rr I rI L- e i o a o m N o c 'O o m a r m �1 v` o <br /> Sampler's Signatur, ��- o �� E c e' o m! -W ° J r cNa 4 <br /> I r z r z a N a � E N N o�, -+ 1. t Comments/ z <br /> x �ma� a �.Zto �mininoao �� a` W S 1Sam le lQ Date Time Matrix � Instructions <br /> zp�w- i `may v� acv �ti t i '9 G 4 C <br /> z "ri <br /> 2- <br /> 27 <br /> Z z v <br /> to <br /> ,amu-1 4 � Cv <br /> W/u- <br /> .r /I <br /> Special Instructions/Comments Re@nq _ Received by�VAD L Sample Receipt <br /> /� Sign -- Sign Total no of containers <br /> pt E/¢Sl fr,#X &SO L-rS /�+fh�p,+*lE[� PrintR Prin� N 'n `�� Cham of custody seals <br /> r Company 5C'��`l - Company Recd in good condition/cold <br /> Time Date I(- � ~9� I, Time !_73— Date it� �- Conforms to record <br /> - <br /> Relinquished by Received by Client <br /> Sign Sign <br /> Print Print I Client Contact/ <br /> Company _ _ — Company <br /> Time Date Time Date Client PhonaK 6 <br /> srrOA CLSTFfC Rel 2199 2�/ <br /> Date _< r / / � Page—1of4V <br />