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Chain-of Custody Number, - <br /> SECQR Chain-of Custody Record <br /> Field Office -7-) <br /> Additional documents are attached, and are a part of this Rei6rd <br /> � � , <br /> Address a 1 `' Job Name r 4�L - <br /> r Location <br /> `4 <br /> Analysis Request <br /> Project# ' `�2' Task# <br /> Project Manager 5►-1r4- 11 +rktr <br /> Laboratory 1-a o m <br /> c <br /> Turnaround Time :2,- x%•�� -- _ x o 22 <br /> } o 2 -20 a <br /> Sampler's Nam d `ic.� s/ �►.. $ go 00 C o 0 0 v 0 ro 0- m r o <br /> pp E r^ +' m 00 Icy go <br /> Sampler's Signature p ai, r E r ago vim _ao m a <br /> x gga ON 2r EN do O� ° U , Comments/ <br /> Sample ID Date Time Matrix s m d w x r�i`° a " a` Instructions <br /> Special Instructions/Comments Relinquished by t Received by Sample Receipt <br /> Sign } Sign Total no of containers <br /> Print 'r — Print Chain of custody seals <br /> ;;r/ , r r� r ►_ Company an , <br /> ` CompanyRecd in good condition/cold <br /> Time _Date tin Tim ,� Date Conforms to record <br /> Relinquished by Received by Client <br /> Sign Sign !�-',f t , A A <br /> Print Print"r A rx A I law, Client Contact <br /> Compa Company ,t! // n 1,4,3t teq, <br /> TiDi Date Time r r Date 11/7.2 Client Phone <br /> SECOR GUSTREC Rav 2M <br /> Date Page— of <br />