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Chain-of Custody Number: <br /> SECOR" Chain-of. Custody Record <br /> (� <br /> Field Office: Sro <br /> Additional documents are attached, and are a part of this Record. <br /> ���.��'��<< <br /> Address: NO Job Name: <br /> v� I �' Location: ICA <br /> S <br /> o' <br /> Project# - 3 0 CaTask# Analysis Request <br /> Project Manager ' <br /> Laboratory <br /> Turnaround Time W 'm ,� <br /> m =m c3 a O v cl <br /> r <br /> v <br /> CL16 <br /> °Sampler's Name rzC2,, o_._ <br /> E o- OV r- Saomo <br /> mmm �E .0 ESampler's Signatur ` omaoa o a ° ocli ca Comments/ <br /> Sample ID Date Time Matrix04 az <br /> - ED a m` <br /> Instructions <br /> 3,5_ <br /> -� 3 ►�zs�9d v � <br /> Special Instructions/Comments, Relinq ish by: Received by: mple Receipt <br /> eSig Sign Total no.of containers: <br /> Print14. r�,&e3 Print Chain of custody seals: <br /> Company Company Rec'd.In good condition/cold: <br /> Time •^ Date J��fr9�' T Date <br /> Conforms to record: <br /> Relinquished by: Receive <br /> Sign Slgn Client: <br /> 14 <br /> Print Print Client Contact: <br /> �cmpa Company Date Time ,Date Client Phone: <br /> SECOR CUSTREC Flev.1195 <br /> Date:_�_ I 'Z�1 �� Page–S— Q'of La <br />