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Chain-of Custody Number: <br /> SECOR Chain-of Custody Record <br /> Field Office: <br /> Q Additional documents are attached, and are a part of this Relkird. <br /> Address: Job Name: <br /> Location: <br /> Analysis Request <br /> Project# 7%�� Task# <br /> Project Manager r <br /> Laboratory �� CO m <br /> Turnaround Time r En e <br /> a U o <br /> Sampler's Name a ' ° <br /> cq pa mo m4 m� a°r <br /> Sampler's SI nature v ro`" m N o °s a s <br /> R 9 o zLO <br /> :W 0 �, N o Comments/ a <br /> r � ra- dw jc�n ic�u � a� i°� a` rv- z <br /> Sample ID D to Time Matrix Instructions <br /> �!3 <br /> Special instructions/Comments: Relinqu' db Received by: Sample Receipt <br /> Sign '� Sign Total no,of containers: <br /> Print r Print Chain of custody seals: <br /> Company EC6 Compan Rec'd in good condition/cold: <br /> Time 9 S� Date �' t Ti Date Conforms to record: <br /> Relinquished by: Received by: Client: <br /> Sign Sign <br /> Print Print Client Contact: <br /> Comp Company 6-m A,u• r <br /> Time Date Time) Date OV/49 9Client Phone: <br /> Date: � �� � Page 1 of j i <br />