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I ;'I Chain-of Custod Nk nibei <br /> SECOR Chain-of--Cy stody Record 30 <br /> Field Office 5ECOP, <br /> Aidd�tional documents are attached, and are a parl of this Rewrd <br /> Address 3 Job Name',—G-A b <br /> C Location 13 25 e W A5S t%t 9 s t <br /> {{ I ii li Suck jb n , bi- <br /> Project # t10 7 Oa •01 Task # a7 II Analysis Request I <br /> Project Manager Zto�n Bo Vvf , <br /> Laboratory Qum 4t r x Q 4; <br /> Turnaround Time a m = U, U) <br /> 16 CO <br /> U ,I m <br /> Name 6� C�rri7 w o a o 7 m�? ° @Ick 0- <br /> Sampler's <br /> 00 Cc 0 0 �� <br /> Sampler's Signature v m o O oo N b a w r <br /> �r Z oa cv oW �N n2° zN `gy COmrnPni E <br /> Sample ID Date Time Matrix s r o CL o M a a n z CD 0 o a 0 i°,r. 1nStfUCt1@I1S ` <br /> 11)7 W15 th'r <br /> 1 0'10 fh`r x II �I 1 <br /> III II <br /> _ it II 4f <br /> ll II � <br /> II �I <br /> - <br /> II <br /> Special Instructions/Comments Relinquished by ' 60 11 Received Sample Receipt I <br /> Sign {� Sign Total no of containers I 2- <br /> Print <br /> Pant 611:tj_ P_ C10 rf-- Print e f5o' Chain o1 custody seals <br /> Compa�n.yY 2 FGQ 2 if Company Recd m good conditionlGold <br /> Time SloO Date E ,I1 Time ! Date:(J:eZj�k Conforms to record <br /> Relinquished by �� Rieceive by I <br /> Sign Sign - Client ._ 5 c,:� _ 4 <br /> Print Print awry <RA"l _ T <br /> Client Contact ''O)h JR'` <br /> Company Company t)A 1-W QA <br /> Time Date Time Date ,/i 94 C Client Phone <br /> If II i I <br /> SECOA CUSTREG R+ 1195 I I t <br /> I� <br /> Date A 1 l 7 1 fb Page�_of <br /> f <br /> II t <br /> I <br />