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r <br /> Chain-of Custody Number <br /> SECOR Chain-of Custody Record <br /> Field Office 0-7�. S a c P a m ed o U Additional documents are attached, and are a part of this Record <br /> Address soII 1-,' 41CIO"Q Pct, ") 14- ICU() Job Name RGA(L mo ytt- <br /> Ro o cr o C o r4i"Ja$ CA G�; L,7 0 Location R,140- bo A C <br /> Project# 01-43p40, 002— Task# Analysis R uest <br /> Project Mana �� #r'' o n i° N <br /> Laboratorya er o m 12 <br /> Turnaround Time "Z 4y U RS o - 6 X @ <br /> a s C a �� 0 m La o <br /> Sampler's Name_ !G A is" ro o ch 1° j� o <br /> m E E m rN o� CO� >� awo m <br /> Sampler's Si nature ~- C®" - m �' o y <br /> g Q 2 r 2 r 2 o a o m E� v+o ;9 cu "a a�` Comments/ E <br /> U M ao 0- <br /> P <br /> o .94ocv roo a do ov <br /> Sample ID Date Time Matrix = _ a �- a �- Instructions z <br /> W - 2 It UI 1�3o wc:i-der <br /> r y <br /> Special instructions/Comments Relinquished by Received by Sample Receipt <br /> Sign �''-' Sign Total no of containers <br /> Print i3,r_io iR Car C21 Print Chain of custody seats <br /> Company S ECO Company Rec'd in good condition/cold <br /> Time I5 LA-7 Date � ti O Time Date <br /> Conforms to record <br /> Relinquished by Received by Client <br /> Sign Sign 6-S.4" !1.{ <br /> Print Print 0SarfrA q tha/aw Client Contact <br /> Company Company/ F l A40 /flf.Cal <br /> Time Date Time l_i y t 7 DaClient Phone <br /> SEWF1 CUMEC Rm 2r99 <br /> Date / / O{ Page_L of A <br />