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�I I <br /> f t <br /> E <br /> Chain-of Custody Number: <br /> i <br /> SEC '" R Chain-of Custody Record <br /> Field Office 077 Q&POffi2 A ft3 Ii l D Additions!documents are attached, and are a part of this Record <br /> r Address 3t�i7 �-ikore Rd S+24{� 1t !i �! Job Name* ar'Cln ,l"Iar 'F <br /> o cl o *dova GAr S;,7U I !i Location "LIS-41 C. San+'I_ T-e Ra. _ <br /> i !IR"Vf r 6a L L C.14 4 �._ <br /> Protect#�77bT�{3627� 11 Analysis Request <br /> °o,4' # <br /> Project Manager • _ u r k ftr-Ioo i e <br /> laboratory-IU F-'F m �, <br /> Turnaround Time to Q61-5LM <br /> atl� �.Q <br /> Sampler's Name—6.(—,V\ _ I r �So 04 p Ct 0 <br /> Sampler's Signature- -- o r {}f,Q <br /> _ r Z E g <br /> Y r <br /> Comments/ E <br /> Sam le ID Date 'rime Manx x _$ m a r n Instructions Z <br /> 2/qIO2 134 kA —p <br /> i 1 <br /> t I <br /> i <br /> II <br /> `i <br /> I{ i <br /> � r i <br /> Special Instructions/Comments Reiin uishpd by Received by Sample Receipt <br /> OYYV npiiles ; Mt�13 e, E fig F, Sign Sign Total no of containers <br /> TA M&I D I P T3 A Print �- Camra Print <br /> � I , Chain Of custody seals <br /> Campany—saC lsk Cum Rec'd in good oonditlon/cold <br /> EtaF 6661 -r-D *& TbbCf7'7ob 477 Tme lb 2 Date'MZ W o2 a ate <br /> Conforms to record <br /> V al i s VAIL-e ! Sr R C Relinquished by tR ed b Client <br /> Sign !! Sign <br /> P�Int �� �f Print t �' Client Contact <br /> Com " Y Company �L ,1. <br /> T e Ip +i Date Time pie 4 Client Phone <br /> 9M—cz5ntEo Flft von <br /> 'I <br /> Date. 2.- /L( / Page of <br />