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0 Chain-of Custody-Number <br /> SECOR Chain-of Custody Record <br /> Field Office ��� OAdditional documents are attached, and are a part of this Record <br /> Address 3W3 Alrz&.ff 40 .00.lae Job Name d&&I� m4nKgT <br /> A4,v,e,hb e_�iz4GV A , 567G Location ;Z35�1 S,51N'T,4 ) Xo4j <br /> W,-'L4X e4AJA1_ <br /> Project#,07A� '7 aa/ Task# Analysis Request <br /> Project Manager_ 41UVYA14'"-r1 <br /> Laboratory a, <br /> Turnaround Time_ <br /> ' m io �� � IL <br /> a U F° <br /> Samplers Name F z o o 0 0 o o o o c� <br /> Sampler's Signature <br /> g 0 rn EW Nm OD <br /> Qm oN a`p 'p a W <br /> C f°� e N m ;�N `o_m -' { Comments/ E <br /> Sample ID Date Time Matrix <br /> w ° ¢`o W _� CO o a 1 r_ a 2 Instructions z <br /> • /41 tv— l I� O 11 3 00075 <br /> ,41 W"O <br /> /ql tvS d sz �c <br /> 41 A/ <br /> Nr W--`I l7�� <br /> 3 <br /> Special Instructions/Comments Relinquis ed by Received by Sample Receipt <br /> Sign ;,_ Sign Total no of containers <br /> Print ��� ���'� *✓ PrintCha <br /> Company Recin of custody seals <br /> J <br /> Company 'd in good condition/cold <br /> j Time �fDate i Time Date <br /> � � TUbl1 �Q��� Conforms#o record <br /> Relinquished by Rece ved by Client 5X11 <br /> cul-,o 11) � St kc- Sign Sign <br /> r Print Pnnt,'�w ,6— Client Contact �A1�C ZG <br /> Company Compan � � <br /> Time Date Time 117 " Date/a, ' s Client Phone :2 <br /> SECOR GUSTREC Rev 2/99 <br /> Date J l /G Page 1 of <br />