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J"1_ I­ i (A <br /> .81 <br /> Chain-of Custody Number <br /> SECOR Chain-of Custody Record <br /> Field Office p77 U Additional documents are attached, and are a part of this Record <br /> Address3 0 Qd cn-10Z) Job Name <br /> r,�W,& & a— Locationyam. <br /> 77C7 y1 Z57,6d420 <br /> Analysis Request <br /> Project# Task# <br /> Project Manager�� gzm�2ti <br /> Laboratory 69k, 6L4a1_eAaiL- <br /> Turnaround Time 6L4adoLdf <br /> OD <br /> m nr LMN <br /> EL <br /> 0 co <br /> Samplers Nam ED0 0.o r o �o ro o ?o m o a o c i iE <br /> m o O m p.v m <br /> Sampler's Signatur Q�1,� _ o �,� 0 LOQ m m aco ° 2 C) r y <br /> U as as a oa oa Mo vN 00a c�010 0 Comments/ <br /> Sample ID Date Time Matrix z � �- ¢� (0 s 0 U)to LMR, a 2 w Instructions z <br /> Special Instructions/Comments Relinquished by Received by Sample Receipt <br /> Sig l _ Sign ZY_lLt4fTotal no of containers <br /> Prin Print JL4,hkSte~'— Chain of custody seals <br /> Company_ 5eee;4 Company Rec'd in good condition/cold <br /> Time eV)7/4 Dated Time JF_11 7 v ate–/O `34> Conforms to record <br /> Relinquished by Received bClient -ort <br /> Sign <br /> Print Print Client Contact <br /> Company Company Client Phone 9wwowo <br /> Time Date Time Date <br /> SECM CUSTREC Rev VN <br /> Date lZ& l CL2 Page 2--of Z <br />