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A DW 101 <br /> Chain-of Custody Number <br /> SECOR Chain-of Custody Record 0 <br /> Field office D 7 7 Additional documents are attached, and are a part of this Record <br /> Address Job Name 7!` - <br /> ��•���•a Location /" Z_05,_-4 1M <br /> Project e7?I"/ � '—'?rask# Analysis Request <br /> Project Manager � f <br /> Laboratory_ �c��-/ , <br /> Turnaround Time_,t:57L._- _,� 0. <br /> °7 �i m cU U U C <br /> �w o �U a mUr n 2 H U <br /> Sampler's Name� �r-� -6 a� r > >"V m � ' -o ce, �- <br /> �- a OE <br /> �o oo ma o mo av m o <br /> CO <br /> Sampler's Signatu o �,� N 0) y m Z-,N <br /> =a 0.o a �o ON �a dnusi �o ov m V Comments/ 3 <br /> Sam le 0 e T Matrix = oo F ¢ _ w a Instructions z <br /> .ru I ae . 1 10 0)2.2-e <br /> I FF <br /> Special Instructions/Comments Relinquished by Received bUSam le Recei t <br /> Sign. Sign Total no of containers ! <br /> Print i t` Print Chain of custody seals <br /> Company SOr-V12Company ffXGG! erg Recd in good condition/cold <br /> Time 9.37 Date -10/ Time I- 37 -Date/0-//-a I <br /> Conforms to record <br /> Relinquished by Received by Client .5 [r-e-dl' <br /> Sign Sign �2 <br /> Print Print Client Contact <br /> Company Company <br /> Time Date Time Date Client Phone <br /> SECCR CUSMEC Rev 2199 <br /> Date I4 / la /0/ Page 1 of <br />