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Chain-of CustodY Number. <br /> SECOR Chain-of Custody Record r <br /> Additional documents are attached, and are a part of this RArd <br /> Field Office "7 2 '� , �, i r ` - _ <br /> Address W / �' `' i Job Name ! LI 1 r t,< t <br /> f , Location <br /> Analysis Request <br /> Project#4-7 Task# <br /> Project Manager <br /> Laboratory ' o ° m U °' <br /> Turnaround Time 2 x o M �, � o <br /> Sampler's Name ' } p omoNN �OO .50 raa <br /> 2-1 <br /> °i4)°° ?N �O <br /> U`° <br /> Sampler's Signature` �u) LO E m— v ~ Comments/=rdT =V N 0 z <br /> Sample ID Date Time Matrix z`O f° a 10.411, 4 Ac <br /> Instructions <br /> �. <br /> r <br /> Sample Receipt <br /> Special lnstructions/Comments Relinquished by Received by <br /> 1 Sign ' Sign Total no of containers <br /> Pnnf i Ana 14 004 it Print Chain of custody seals <br /> '3r!�� Company < � ' Company ,f Recd in good condition/cold <br /> Time .Date f UU Time Date Conforms to record <br /> Relinquished by � Received by Client <br /> Sign Sign <br /> PnntPnnt 1 Client Contact <br /> Company Company I td r <br /> Client Phone <br /> Tlme— Date Time 1!T I/e, Date&Z <br /> SECOR CU$TAEC Rev 2M <br /> Date Page of <br />