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Chain-of Custody Number: <br /> SECOR Chain-of Custody Record <br /> PSAdditional documents are attached, and are a part of this Record. <br /> Field Office: z ' o f,-r{4-1 r -r <br /> Address: 0 W U SJ S 3E0 Job Name: <br /> Location: <br /> . . ':7013 '� —QL T sk Analysis <br /> # " <br /> Project# <br /> j� SUiii•i N: riu�b�l kEF: HLiEVe <br /> Project Manager V0j"� i , CLIENT: 5-eCuk-ED <br /> Y Al cs0 " �� DUE: U;inyi53 <br /> Laboratory a� = �N N REF 9:45314 3 <br /> Turnaround Time a <br /> C <br /> g m _ <br /> a <br /> 0 10 <br /> �- <br /> / W o o �o o ' o <br /> Samplers Name E E 0 o N m d mo N ,v_0 �0 aZ, N <br /> 2 w <br /> Sampler's Signatur o = _ = o a 1 a $ '@ N _o ,�" a Comments/ z' <br /> Sam le ID Date Time Matrix = om a o° >° _ w N° o ° Instructions <br /> Zs 9 '30 Wctt r.• A- <br /> 0 U <br /> G �3 S3d <br /> JI <br /> n <br /> • � ! jz.Ot7 <br /> - p 13;3Q <br /> Relinquish � � Received by: Sample Receipt <br /> Special Instructions/Comments: q n Total no.of containers: <br /> Sign <br /> i f a !a Prin Chain of custody seals: <br /> J.' Print <br /> Company U Com an Recd.in good conditio <br /> n/c <br /> o <br /> Id: <br /> Time Date Time /O at Conforms to record: <br /> Relinquished by: Received y. Client: <br /> J S g rl Sign <br /> l� Print 4! ' Print Client Contact: <br /> Company Gds ,,>/6 Company <br /> Time Date Time 6 Fi`�� <br /> Date Client Phone: <br /> nI.1/p6 <br /> Date: Page / of <br />