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• 3 • Chain-of Custody Num <br /> SECOR Chain-of Custody Record6_0� �cc,o <br /> Field Office 7.7 Additional documents are attached, and are a part of this Record <br /> Address t Ot. Job Name <br /> [ ASG Location gS' <br /> 63.�7d <br /> Project#-771V7.-+'!1 7Ta sk i Analysis Request <br /> Project Manager.___ .+ 44an:n.- <br /> Laboratory o y e <br /> Turnaround Time— -��` y CO <br /> 20 `� ro^ c <br /> " <br /> 22 U Uw <br /> o-' I I GU x "U O n <br /> Samplers Name-5-.S <br /> C o oN 0oo Q0'0 <br /> V ca coo m ��Samplers Signatur w m , <br /> U - U C2 <br /> � � jvas as a °o N v m Comments/to 03 Sample ID a <br /> Instructions <br /> I <br /> Special Instructions/Comments Relmquishe Received by Sample Receipt <br /> Thr®y7dQ I�.�� Sig Sign Total no of containers J <br /> Print Print Chain of custody seals <br /> Company Company Rec'd in good condition/cold <br /> Time Date Time Dmte Conforms to record <br /> Relinquished by Received b client C�iQ <br /> Sign Sign s <br /> Print Print Client Contact��" <br /> Company Companr <br /> Time Date Time Z- CG pate � Client Phone <br /> SEGDR CUSTREG Rev&99 <br /> Date _ ��3 l�� Page_L of <br />