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Chain-of Custody Number ��I <br /> l <br /> SECOR Chain-of Custody Record <br /> Field Office 7 7 Additional documents are attached, and are a part of this Rekord <br /> Adcress� C /- D=� Job Name <br /> r' Location SSG 1 s7 C/�M;'d <br /> � { <br /> I Analysis Request <br /> Project#��'??.71 Zo�'G. ��'3 Task# <br /> Project Manager v� u lr <br /> Laboratory �/fF o S- <br /> l � N U c N <br /> N C `\ L <br /> Turnaround Time a� Ln 03� <br /> = � �N y � <br /> ❑L u� j pU CO m o <br /> Sampler's s Name °'`" °' ° <br /> o c7 _(7 <br /> p m° ° m �0 00 Coo od 4)0 � a°O COC_- � 1� v o <br /> Sam ler's Si nature a C m N °'O 'N 0 � Y m e JO <br /> Sampler's g <br /> rn E �22 0 ca w c m J t <br /> V <br /> 0-F) ao a �o oN �o mN ma ov �' U ~"U Comments/ <br /> Sample ID Date Time Matrix x CID m c� ( _ N"0 a� r" C� Instructions z <br /> 02 <br /> f � x <br /> �^ f Su o � ,� <br /> / r3o ,l x 13 <br /> 1600 <br /> 6.00tt o"S4 <br /> Special llnstructions/Comments Relinqu d by Received by Sample Receipt <br /> Sign - Sign Total no of containers <br /> f Print 600i lk tie L,02- Print Print Chain of custody seals <br /> Company `�� Company - Recd in good condition/cold <br /> Time 13. 37 Date 7'19"41� Time Date Conforms to record <br /> Relinquished by Received,by Client - <br /> Sign Sign <br /> Print Print L's" Client Contact <br /> Company Com any <br /> Time Date Time 13:2 Date o71 Client Phone <br /> SECOR CUSTAEC <br /> � Date -o� 10o Pagof <br />