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z Cham-of Custody Number: <br /> SECOR - Chain^of Custody Record <br /> Additional documents are attached, and are a part of this Record, <br /> >'ield Office: �' <br /> ✓ t � Job Name: <br /> Address <br /> e1Ad Location: kl�nao X. AJ <br /> d <br /> Project# 0 `o Z Task# Analysis Request <br /> Project Marna er <br /> Laboratory. N " a <br /> Turnaround Time a T a I 1 o <br /> QD <br /> a N <br /> _ �_ m <br /> Sam ler's Name IQ <br /> JE <br /> a „� U o p q 1 n m o �� m <br /> P r aN 0% mo 9 -0 �y <br /> Sampler's Signatureoar a g m o .g Comments/ z <br /> Sample ID Date Time Matrix Y- I CO F_ a _ � e` a t- w Instructions <br /> Al <br /> 2V'2 <br /> {� <br /> � I <br /> 2. <br /> Special instructions/Comments: Relinquishe Eby: Receiv by: Sample Receipt <br /> Sign .-- Sign Total no.of containers: <br /> Print Print �1�-he Chain of custody seals: <br /> Compan 5` ed Company Z`�m 14 Recd.In good condition/cold: <br /> Time `© Dated' Time 1 Q: !S Date - -PLP Conforms to record: <br /> Relinquished by: Received by: Client: <br /> Sign Sign <br /> Print Print Client Contact: <br /> Company Company <br /> Time Date Time, Date Client Phone: <br /> SECOR CUSTRE Rev.1195 Ode <br /> Date: 2 Page-4of <br />