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i i i i i i i i i = i M I• imi <br /> SL Chain-of Custody Number. 9 �P <br /> SECOR Chain-of Custody Record <br /> Field Office -7 7 Q Additional documents are attached, and are a part of this ReAbM <br /> Address / - �'/� Job Name <br /> �! Location <br /> Project# 0`77 Y_-__2,4_�92_Tqsk# C'X.� Analysis Request <br /> Project Manager `!� oK <br /> 1.Laboratory m coo U � m <br /> Turnaround Time N VC,n _ ~- <br /> a � 5 2 <br /> o m e <br /> Yc o mV a mU d 3 w U <br /> Sampler's Name $ a Q m u o o 0 m o °0 4,,o a r m <br /> Sampler's Signature E v W m m W �'co y a <br /> U Q c o O o N 6 E N m o 19 N o y a ?L Comments/ E <br /> Sample ID Date Time Matrix = m a _ a �° a ►�- IL, Instructions z <br /> ✓�' � �s7 r <br /> � � 1 <br /> -.37 <br /> 10 <br /> Special Instructions/Comments Rellnquishe y Receiv y' Sample Receipt <br /> Sian Sign Total no of containers <br /> Pnnt Print Cham of custody seals <br /> Company`"` n Comp Rec'd in good condition/cold <br /> Time 7- ) Date Tune Date Conforms to record <br /> Relinquish by Received by Client <br /> Sign Signr <br /> Print Print 10.4r:.4 ?dU Client Contact_ <br /> Compa Company- kd--r-_6MA)111y <br /> Time Date Timed Date y n 0Y•V Client Phone , <br /> SMM a STRFC sae,•use I <br /> Date / a I I Page of r <br />