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Chain-of Custody Number:. <br /> SECOR Chain-of Custody Record <br /> %Additional.documents are attached, and are a part of this Record. <br /> Field Office: <br /> Address: 'e w Job Name: <br /> s�' �z ' <br /> ILI'/ `1�/D S _ Location: <br /> Analysis Request <br />' Project # Task # <br /> Project Manager r S <br /> Laboratory - 6- - + 9 0 <br /> CU <br /> Turnaround Timec J kmo <br /> a w 'n� o mg <br /> Sampler's Name �' d a m chi 0 Ooc o o?! �'o el m d� °1 �' �Q N m's R C,4 O J N E <br /> Sampler's Signature Q _ S O N ry" O E N m N o -1 . Comments/ Z <br /> U da 4 0 oc� ma dcv m0 0� - U <br /> Sample ID Date Time Matrix s ! m a,o z�o a,o a 'v Instructions <br /> xi <br /> g <br /> Z :00 <br /> a- 13 <br /> S - <br /> (5, <br /> Special Instructions/Comments: Relinquish by: Received by: Sample Receipt <br /> Sig Sign Total no.of containers: <br /> Print !rY Print Chain of custody seals: <br /> Company a Co ny Reed.in good condition/cold: <br /> Time Date 41me D Conforms to record: <br /> Relinquished by: Received by: , <br /> Sign <br /> Sign Client: <br /> _ <br /> Print - Print A`' Client Contact: <br /> C any Company <br /> ime i— Date Time W5 Date �6 Client Phone: <br /> SECOR CUSTREC Rev.1195 <br /> • Date: 1 —76 Page 2 of <br />