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Cham-of Custody Number X24 <br /> SECQR Chain-of Custody Record L7,;�Cj <br /> Field Office f, -7-7 D Additional documents are attached, and are a part of this Record <br /> Address _3"2/ —7 _ j -JSo^ I�d 5;, 4;�-- Job Name <br /> Location v 5? <br /> Project#7 7bT `l,,73-7 Task# Analysis Request <br /> Project Manager��h c3 <br /> Laboratory <br /> Turnaround Time <br /> ID <br /> z z z o Om <br /> 'a °mSampler's Name ino o o <br /> No^ m <br /> C14m E ESampler's Signature ❑ C w in W WE N E n N <br /> ECL Eo (M 0) c Comments/ <br /> Sample ID D to Time Matrix <br /> U o P o r a- >o �cD a o n a2 <br /> Instructions z <br /> Special Instructions/Comments Relinquish Received by Sample Receipt <br /> Sig Sign 114 zY;d -:raw,-S Total no of containers <br /> Print t w! .. Chain of custody seals <br /> Company Company cQ Rec'd in good condition/cold <br /> Time 6_2�Date A,> Time �1 Date b z Conforms to record <br /> Relinquished by Received by Client <br /> Sign Sign <br /> Print Print Client Contact <br /> Company Company <br /> Time Date Time Date Client Phone 31:3J <br /> SWOR CUSTAEC Re,2W <br /> Date Page of <br />