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f t <br /> Chain-of Custody Number <br /> SECOR Chain-of Custody Record <br /> Field Office 0 Additional documents are attached, an are a part of this Re brd <br /> Address Job Name r <br /> Location L� t` <br /> L <br /> Project# 0 #t � ����ask Analysis Request <br /> Project Manager <br /> Laboratory ° 0 LA <br /> Turnaround Time = 2 ro P� QQ� <br /> Sampler's Name a' � e'` ro� N n o�, o <br /> P o Uo po mo o av m ,r <br /> Sampler's Signature $ °'r C: o m m J Y y 2 <br /> w g = _ = n c7. `v E; N m :°N o "r+ Comments/ <br /> U d d0 d O ON �O NCV MO pv r m U ` <br /> Sample ID Date Time Matrix x ►- CO >,o = a a �} Instructions Z <br /> Special Instructions/Comments Relinq ed"by;:— Recei d by Sample Receipt <br /> Sign -- 1 '.`= Sign ` ' Total no of containers <br /> t <br /> Prin ,-�= r � Print _ Chain of custody seals <br /> Company._ ��� �� __ ___ Company Rec'd in good condition/cold <br /> Time h Date '' Time Date Conforms to record <br /> Reluished by Received byy Client V <br /> Sign Sign <br /> Print Print Client Contact <br /> Comp Company 1 r- Z <br /> Time Date Time 1 _ Date Client Phone <br /> SEGOR CUSTREC Rev 2189 <br /> Date � � � Page of .� <br />