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Chain-of Custody Number <br /> SECOR Chain-of Custody Record ()4s,7 <br /> Field Office a 7 7 Q Additional documents are attached, and are a part of this Record <br /> Address -9,0/7 ! +`� d� A, Ste„' _ /rte Job Name al/ �a� <br /> Location <br /> o 7 737 Analysis Request <br /> Project# Task# <br /> Project Manager <br /> Laboratory <br /> Turnaround Time_ y <br /> Sampler's Name�`� s�'� o a o r Q 10 m a iv o m o o m o <br /> Sampler's Signature G �,n v E m o m n <br /> Tiao do a °o oN �� mN mo ov °m g Comments/ <br /> Sample ID Date me Matnx r-co co r ¢0 Co.a ca COrO co co n a` Instructions Z <br /> Z Ao 4--;- kt2Dl 5 d <br /> Special Instructions/Comments RelinquishedReceged by sample Receipt <br /> Sign 9��Q�Sign Total no of containers 1 <br /> Pring r•4 Print_ ad 4!el to CoCh i k. Chain of custody seals <br /> Company s ®� Company SECOR—_ Rec'd in good condition/cold <br /> Time Date_6?9/i g,& Time Date I I 01 <br /> Conforms to record <br /> Relin fished by Receiv y Client , ! -can <br /> Sign Sign <br /> Print <br /> Print Client Contact �pdc) � <br /> Company Company <br /> Time--8 �- Date v Time-e_lDate ! Client Phone g6/—dy <br /> SECOR CUSTREC Rei 2M <br /> Date _�Z— I �� l CJ( Page L of L <br />