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! t <br /> Chain-of Custody Number, <br /> 4 o <br /> SECOR Chain-of Custody Record o ae <br /> Field Office 0'7 -7 Addi#bnal documents are attached,and are a part of this RAW M <br /> Acdress '?oe? A4 0 Job Narne ��' /�`��`/ ° <br /> r. � rr o f <br /> ca <br /> - - - -�'tU Ca r�va . C1) 9,%-70 Location -- i�nkfif�J ._ CD <br /> Project# 077,4?b%.003 Task#_ Analysis Request <br /> Project M anager -a ti�'c i g i�L--- <br /> Laboratory K(Pr- L5 p { <br /> Turnaround Time <br /> i t? F y OU Q o <br /> n proSampler's Name fi� E - 0 c <br /> Cr eco Q <br /> Sampler's Signature_�1---- c E °'d 'N o N <br /> o co" <br /> LO = E b °� E �a�o' Comments/ <br /> a� a �u c� <br /> U 4 o a a o b o n, o o v U �►� 7 <br /> Sample ID Date Time Matrix m F$t m >cv"M r(D V)11D 0.go I a 2 Instructons r' <br /> lei L' <br /> e rr O <br /> }— X <br /> -- n <br /> CD <br /> 4— <br /> LL <br /> 0 <br /> rV <br /> cc <br /> A <br /> CO <br /> Special Inst clionsJCommen`s Relinqurshheeo by Received by Sam leRecei t w <br /> Sign -, Y Sign Total no of con]ainers <br /> Print D,*rd Ir�,� :v,6 4 _ Print Chain of custody seals <br /> Company q -^L Company -- ' Reed in good condrtroniccld <br /> Time J 3") Date Time _Date <br /> -- Conforms to retard <br /> Relinquished by Received bv Client <br /> Sign------ Stgn <br /> Print _ ___ Pr M/ Of., Client Contact -° <br /> Company Corn o Cn <br /> Time Date Ttma } � Date��M)_ C11ern Phone <br /> �c�n ass aec ac x¢, o <br /> Date __ _J 1 _ E +� Page <br />