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Chain-of Custody Number-- <br /> n�� SECOR Chain-of Custody Record <br /> Additional documents are attached, and are a part of this Record <br /> Field Office 077 <br /> p� �p Job Name <br /> Address <br /> Location <br /> Analysis Request <br /> Project # 3 003 Task # <br /> Project Manager w�i <br /> LaboratoryC o d <br /> C <br /> Turnaround Time co <br /> a0 LO <br /> o � t o <br /> t)t) 1�Z � o o� � <br /> LU a� > rn— m.. � 0 <br /> Sampler's Name r- o co N CL <br /> O c a o� coo y <br /> a0 E E �- o mcg m >N ua _ y <br /> Sampler's Signature a ��, ° m°° R'- E� y N o ° a Comments/ <br /> U a0 ao a °o ons, �o dcv �o ov m U <br /> Sample ID Date Time Matrix <br /> _ i-cc co im- m >(0 10 N w a Z r r- Instructions Z <br /> y zo Vt►G'uI74 <br /> W _ z,,�x� 101275 <br /> Special Instructions/Comments Relin*qhlr Received Sample Receipt <br /> Sign Sign Total no of containers <br /> PrintU Print Cham of custody seals <br /> Company Company. Recd in good condition/cold <br /> Time o%`r Date o+ °I Time /� Date Conforms to record <br /> Relinquished by Received by Client -?c2soR <br /> Sign Sign94WAl <br /> Print Print Client Contact <br /> Company Company Client Phone�16 <br /> Time Date Time _ Date <br /> S 7 ['VStREC flet 239 <br /> Date � r l f � / 01 Page Y= of <br />