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I r a i <br /> Chain-of Custody Number: <br /> SECOR Chain-of Custody Record <br /> Field Office: I <br /> El Additional documents are attached, and are a part of this Record. <br /> J s. <br /> � x0 Job Name: C <br /> Address: C � <br /> Location: <br /> c / /M C <br /> q J Tas Analysis Request <br /> Project# <br /> project Mana er, <br /> Laboratory <br /> Turnaround Time r m <br /> a m U o LM <br /> m �m i6 cV mU j U <br /> _ <br /> : O `DC7 <br /> Sam <br /> CL <br /> v a bE a o 7 �p Q7N m0 fp b a-0 o N <br /> mSampler's Name � UgSampler's Signature �; m F= m V_ fl- <br /> > a iy <br /> oEa oiONm 19 F4 6— v Commentso Zr cv xw COo sr� <br /> eID Date TimMatrix Instructions <br /> Ix <br /> Wairy <br /> .Q x y <br /> Special instructions/Comments: Relinquish Received by: Sample Recei t <br /> Sig gn Total no.of containers: <br /> Print Print Chain of custody seats: <br /> Com7�d <br /> S Com Rec'd in good condition/cold: <br /> Time Date Date Conforms to record: <br /> Relinquished by: —' Received by: Client: <br /> Sign Sign res •A1 b=Aga ww,%1 <br /> Print Print 1 Client Contact: <br /> Comp Company K�fr'• A�iH+-,'CG.f <br /> Tirtse Dale Time i lsice+ Dateo.__Y2°i<?_ Client Phone: <br /> S��us�c ate.zne <br /> Date: �Q Page of <br />