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t <br /> Chain-of'Custody Number: 3�� S <br /> 'ECOR Chain-of Custody Record <br /> Field Office: <br /> -7 /,"' elAdditional documents are attached, and are a part of this Record. <br /> Address: !� P+''/ �'� •"'� �� �.� ' 0 Job Name: � <br /> � <br /> �1 1�`I 0'7rt 's j� � T �� Location: �f <br /> 0 c' <br /> P roject#5-0 0 1?0 D// -d 3 Task# Analysis.Request <br /> Project Manager —e <br /> Laboratory-"" Cj <br /> r r <br /> ���ifr i �sC d� cn �C c <br /> Turnaround Time o <br /> D a <br /> a. 0 Z mID IL <br /> Sampler's Name tir v m E ' o'D 51 g ° w °' <br /> Sampler's Signatur �, asp `* m =mm 'm � `� �- E <br /> �r ate , o Comments) z <br /> Sample ID Date Time Matrix F-a5 �w � ¢� a. (00 Q!8. r` Instructions <br /> :V <br /> Special Instructions/Comments: Relinquish Rem b Sample Receipt <br /> Slg Sign Total no.of containers: <br /> Print Print fi' E Chain of custody seals: <br /> Company 5J5�6iZ Company Rec'd.in good condition/cold: <br /> Time � + Date — Time _ Date 2g Conforms to record: <br /> Relinq ' h Received by: <br /> . Sign Sign Client: <br /> Print 244- Print Client Contact: <br /> Company % Company <br /> Time Date Time Date Client Phone: <br /> SECOR CUSTREC Rev.1M <br /> Date: JZ Z 1 �7 Page of�_ <br />