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tChain-of Custody Number <br /> SECOR Chain-of Custody Record <br /> Field Office 077 <br /> 0 Additional documents are attached, and aro 503103 <br /> Address Job Name T�f ©K <br /> vIQ Location _jf 4 0 . fAg , Gay <br /> SS <br /> Lam., <br /> Project# 7'7Ir + Task#ciao Analysis Request <br /> Project Manager <br /> Laboratory ��4 o 0 <br /> Tumaround Tme. S7VIat�Pb <br /> S2 <br /> Q- o m c o <br /> m QS cp > OV v <br /> �C o �°U mC3 = N U <br /> Sampler's Name V ►-o a o N O 0 c 0 0 b a 48 <br /> Sampler's Signature E v m m m a m '-" i 0 J -c"@ <br /> � X � <br /> IJ ° z T z T z o a ° i o o N Comments/ a <br /> 73z <br /> U ao o a o oa �o mcv my m <br /> Sample ID Date Time Matrix x m m ¢ > _ m(o a.m �t. a.2 f- Instructions z <br /> 1/03 w4m Y <br /> 1 M5 1 100DQ5G <br /> u)'Z aS <br /> - 1 1717 <br /> 0-7 lao <br /> Ui- r57.SS <br /> Lmbob <br /> Special Instivctions/Comments Relinqhe b Received by Sample Receipt <br /> Sign Sign Total no of containers <br /> FDF gMtAED Pnnt Print Chain of custody seals <br /> Company Company Recd in good condition/cold <br /> Time 4 Date 16 Time Date <br /> Conforms to record <br /> -- Relinquished by Rece Client 5+15.zk <br /> Sign Sign <br /> Pnnt Pnnt Client ContactM JAI <br /> Company Compan <br /> Time Date 'rime 2-`� D Date ft Un Client Phone <br /> secoa asr�c riev.ves <br /> Date I 16 Page—1 of <br />