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Chain-of Custod Number �Z <br /> SECOR Chain-of Custody Record <br /> Field Office 07 Additional documents are attached, and are a part of this F?Ard <br /> Address 4 7 L �} pd Job Name /ZA,�4 hicK <br /> !'i4 S rJ Location 23 ' <br /> Project# 7. LaoG Task# Analysis Request <br /> Project Manager ,-T <br /> Laboratory r� r <br /> Turnaround Time <br /> (U <br /> C <br /> _ ) CIO <br /> Sampler's Name ( a 0ama Q <br /> o <br /> CID co ` °O O aSampler'S Signature <br /> C <br /> Co <br /> E� iu <br /> Sam le ID Date Tl ieU o o a o N m E N W itl N 'o•f9 a W <br /> Matnx x m r-m Comments/ E <br /> 0 t t0 ~ Instructions z' <br /> I �z 7 qfJ 0 L - eel <br /> C /`Cl• — p2 <br /> Special Instructions/Comments Relinquished <br /> Received by Sample Receipt <br /> Sign Sign <br /> PrintPrint <br /> Total no of containers <br /> CompanCompany Chain of custody seals <br /> Recd in good condition/cold <br /> Time�_Date "' z�- h� Time— Date <br /> Conforms to re <br /> y <br /> Relinquished by Received cord <br /> Sign Sign _ j Client <br /> Print <br /> Print Client Contact <br /> Time <br /> CompanComps <br /> AEC Rev 2199 Date <br /> Time Date U)� Client Phone <br /> SECCR CUS7 <br /> Date /L4 ~ / Page—1 of <br />