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• Chain-of Custody Number: � <br /> SECOR Chain-of Custody Record <br /> Additional documents are attached, and are a part of this Record. <br /> Field Office: � � <br /> Address: 3 eS Z� Job Name: d✓t tr s ,tit P k 1�S <br /> i reZ f 0 ' Location: a e%>6P <br /> Project# Oz Task# Analysis Request <br /> Project Manager <br /> Laboratory 1 =N a <br /> . Turnaround Time d o mN <br /> � m <br /> 16 <br /> Sampler's Name Ch4g �Ar <_6 u N O c m vm w <br /> Sampler's Signatur m v E w = o o w o y w E <br /> U ao ao a Eo oN F. dN d� oa c d v Comments/ Z' <br /> Sample ID Date Time Matrix x r w m r a > x w m w a w r n a.M Instructions <br /> - sw— I -s b oo I wcrf f..- Q <br /> SW-2 3i M501 wu+f✓ �+ <br /> rJ 3" <br /> I S^ "1 <br /> ?0 ' <br /> S sP 2 s <br /> Special Instructions/Comm, Relinqui y Received by: .� Sample Receipt <br /> Sig Total no.of containers: <br /> IWf I �1J j Print e _ f 4 ! ' Print v i -� Chain of custody seals: <br /> Company U Company Recd.in good conditioNcold: <br /> Time Date Time ,i®Ve Date Conforms to record: <br /> Relinquished by: Received by' e'�i <br /> Sign /ee �7 Sign Client: <br /> Print ed' t Prin ° s <br /> ter--- Client Contact: <br /> Companya l rsaxe�// Company <br /> Time AG2'/ Date y_�� Time G Date V2ff Client Phone: <br /> Fa..,res <br /> Date:� Page of <br />