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Chain-of Custody Number: <br /> SECOR Chain-of Custody Record <br /> ro QAdditional documents are attached, and are a part of this Record. <br /> Field Office: C�"f 0 4 0 '20 <br /> Address: W � <br /> O ; �� �� 360 Job Name: <br /> �0 rr to,rjgD� 9� 2 a Location: �!d <br /> i <br /> s <br /> Project#7o139- 00'(- OZ Ta k# AnalysiRequest <br /> Project Manager t ✓ k� d <br /> Laboratory 6&/VV'10 Q N _ <br /> d <br /> 41DTurnaround Time r a m a d o °'U <br /> N ` <br /> a �o '- cV > Ocoo " <br /> d =� v0 ¢ 5 2 o <br /> a mSamplers Name > O <br /> EE Dy y° <br /> aE <br /> Z3Samplers Signatur oo Instructions <br /> Sam Date Time Matrix = 0 m F a <br /> I <br /> r u <br /> J 1 <br /> _ O 1 <br /> S � <br /> Relin uis b Received by: l� Sample Receipt <br /> :#1 <br /> Sign <br /> S`p/eciJal�I�nfstructJi�ons/Instructions/Comments: .y [ q y Total no.of containers: <br /> Sig <br /> / Print �. f P do Print Chain of custody seals: <br /> Company fJ Company Rec'd.in good condition/cold: <br /> Time Date Time Date l>' Conforms to record: <br /> Relinquished by: -1 Received by: <br /> Sin / Sign Client: <br /> 9 <br /> Print �l Print Gee Client Contact: <br /> Company Company <br /> Time �N/ Date Time /4 Date Client Phone: <br /> ne .1M <br /> Date: Page—of <br />