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• Chain-of CustodV Number <br /> SECOR Chain-of Custody Record <br /> Field Office 07 7 Additional documents are attached, and are a part of this RArd <br /> Address 70,-'7 &CGOXE 40 { ���o Job Name l�'�.^� (� Mo r <br /> . v_ C�rr/n*� r ��:o�'�� Location �j-�i! 1. �� 14 <br /> 6k G/'4 <br /> Project# 077 ,42 O(c.003 Task# Analysis Request <br /> Project Manager Jc Ett7EKD�JEG �� <br /> Laboratory Q Fr ` <br /> C7 O m U y <br /> Turnaround Time / Gel cF/� =o y �, �, cc <br /> a_0 O o a r; O U (mJ R } -, c <br /> Sampler's Name -2 L � °i`� ° " a 3 <br /> H O O O VO QO ND ro0 p�j C] .2 y ^Y <br /> Sampler's Signature m E v m �'04 N W o o N 3 o J N V a <br /> ' O W 0`0 r, - a <br /> V a0 a0 a °O OCQ �O �N �O rCV J Comments/ E <br /> Sample ID Date Time Matrix = co r co I a'( (0 r a w a` W ` Instructions z <br /> GA (-3 r <br /> 64101— <br /> rd 4 <br /> 2 x <br /> l-2Sr Z6 <br /> r32o 'x _ Z7 <br /> FF I <br /> Special Inst ctions/Comments Relinquished by Received by Sample Receipt <br /> Sign Sign Total no of containers <br /> Print OjAJ S t•A-6-✓ti Print Chain of custody seals <br /> Company Company Rec'd in good condition/cold <br /> Time )3 '37 Date 7!y- Time Date <br /> Conforms to record <br /> Relinquished by Received 0 Client <br /> Sign Sign �r <br /> Print Print v Client Contact <br /> Company Compan <br /> Time Date Time / � Date 0_71 Client Phone <br /> SECOR CUSTREC Rev 2M <br /> Date -7 / / �'+� Page of <br />