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Chain-of CustodyNumber:. <br /> SECOR Chain-of.Custody Record <br /> Additional documents are attached, and are a part of this Record. <br /> Field Office: <br /> S �Zp Job Name: <br /> Address: i <br /> w _ Location: <br /> C <br /> Analysis Request <br /> k . Project # SOZ33 `CJD _d Task# <br /> Project Mana er J � <br /> _ iv 2 <br /> Laboratory u O - C <br /> N �t _ C <br /> am y ca � <br /> Turnaround Time A <br /> a0. m U D VJ;T!9 � <br /> o �a - Cs3 �U U N <br /> z 0.-o <br /> m O ` <br /> zEs � o�- 00 _JSampler's Name Comments/ <br /> Sampler's Signature , 6 <br /> oa QFa8 >� a U Instructions <br /> Dale Time Matrix Wm N w a d 2 3Sam le ID ' <br /> 13, <br /> t' <br /> D W 2 7 <br /> w - 3 <br /> n W - Lo <br /> Received by: Sample Receipt <br /> Special instructions/Comments: Relinqui h d by: Total no,of containers: <br /> n � -Sign <br /> sign Prirn Chain of custody seals: <br /> Print ny �I Cony <br /> Company Recd.in good condiiionlcoid; <br /> `,� � pate �� Ime Da Conforms to record: <br /> Time <br /> Relinquished by: Recei by: Client: <br /> Sign Sign <br /> Print - Print Client Contact: <br /> Cony Company ? <br /> me <br /> Date Time 4SC� _�Date I b I Client Phone: <br /> 5ECOR CUSTREC Rev,1795 r L <br /> Date: r � yU page 3of <br />