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Chain-of Custody Number <br /> CD SECOR Chain-of Custody Record <br /> a- Field Office Additional documents are attached, and are a part of this Record <br /> Address 9912 V—Spa-V Job Name b4 e- <br /> lvuj 7-axL <br /> �0.C.'b 7 LocationAve.. <br /> Project#t _ Task# Analysis Request <br /> Project Manager <br /> C3 Laboratory 0 o p lv U pl <br /> �s Turnaround Time a W z N ro W l �7 <br /> a h a IOL d ' o Ep U) C <br /> LO Sampler's Name ti <br /> Sampler's Signator fel m E Ecc o O It si P� o y o <br /> bi J ? N <br /> C) <br /> a 0 EL O tL o a O N ro 0 d N w N O CL <br /> v Comments/ Z <br /> x <br /> Sam le ID Date Time Matrix s �ro m +- a r rr)co a$ �° a`g Instructions <br /> S- io t 4 l- So t L )( X <br /> ss- � <br /> ss 4- <br /> � 6 <br /> Q <br /> m <br /> Q <br /> U <br /> Q Special Instructions/Comments Rein e4dyReceive Sample Receipt <br /> Sign Sign Total no of containers <br /> Print M'KE Print t f Chain of custody seals <br /> Company �+�-0Q Company f Rec'd in good condition/cold <br /> c*� <br /> Time 13,'t y _ Date 10 1,R 199 Time r f Date Conforms to record <br /> Relinqu d y T Receive by � <br /> SignSign Client T;,— y <br /> co Print 5�e+2 00 1f Print _ w <br /> ComL01pany 1��th a Company Gc q'�ar Client Contact <br /> Time �45� Date f0 8 13 Time ID 5. Date-W!--7 Client Phone <br /> E— SEC q CU57REG R¢v fl85 <br /> C> <br /> O <br /> • * Date S 1 of I <br />