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Chain-of Custody Number. <br /> SECOR Chaim-of Custody Record <br /> i )T �� rove�: <br /> UAdditional documents are attached, and area part of this Record. <br /> Field_ Office <br /> }. fit. £�14.,1. 4�# i:; <br /> Job Name: „ ) �C *,.�+ <br /> Address: ` <br /> :ice✓F -' h t I 'i i U t �j�� bs Location- <br /> 1 » i#J L.1 W'(i;}1 A _F� �• r SC 1940 <br /> Project# .�p 4.6 6 11 b> Task# I Analysis Request <br /> Project Manager We,vnw . ..o', <br /> Laboratory f .Tt ✓, !�'�_. f. ->�. �; <br /> TurrlaroUrli�Time, Y+er r/a�a r r#,�r Cs _ Y <br /> SOS 6 > a <br /> - 24� -2 3 o <br /> 5arrmples's Name; : . ra m "' o =o Q C r <br /> Sampler's Slgnatur r r v NO .2- <br /> 21 3 •o.` . <br /> r Comments/: <br /> ti o a o €- o o-wt cs sts sv u�a Z <br /> Sample ID. Date Time, Matrix . �—to �to ¢w CD m 10 �1 r- - - - Instructions. <br /> `x <br /> }et ?� x <br /> 15 7 011* soil x <br /> Special Instruc#ions/Comments: Relinquish ley: Received by: Sample Receipt <br /> Sig Sign Total no.of containers: <br /> Pant Print Chain of custody seals: <br /> Company Company Recd.in good condition/c6 d: <br /> Time Date V= - Time Date Conforms to record: <br /> -Relinquished by: Received by: <br /> Sign Sign Client: <br /> Print Print Client Contact: <br /> Company Company <br /> Time Date " Time, Date Client Phone: <br /> 1110OWWO Rev.7185 - <br /> Date: /4 130 Page�of <br />