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7 7' <br /> ------ ------ <br /> Chain-of Custody Number: <br /> SECOR Chain-of Custody Record <br /> Additional&66rnents are attached, and area part of this Record. <br /> Field Office: . 01T - <br /> qq - -321Y1,1 15�� a-m t 4 <br /> Address: - : :, <br /> . /7 Job' e: 1—o e- <br /> 4a e r1r'10�e4 f1f. ry• elf Location <br /> e_ <br /> Project# n71'2 -dol -0 Task# t06147.2 Arialysi's Request <br /> Project-Manager T. w lep- <br /> Laboratory xc&_Ine M o �. 8 <br /> Turnaround <br /> (L 120 <br /> 8 <br /> Z <br /> Saris lei's Name .9 Rt <br /> Sampler's Signature <br /> Ln U, Comments/ <br /> Sample ID Date Time Matrix 1 fi. ;5. 1 P;z CE 2 Instructions Z: <br /> /4f KI 5'-r N-5-f 6 'A?o <br /> W.,IF 0323 1 <br /> U U1.5--2 0 -0 0_7q (P,37 Lt I <br /> u/ I Wo 1--0 50_7q(a a-Z <br /> f So (p I <br /> 1& 50-7903-7-1 C' <br /> P;2 Sco Ct (�F)l <br /> Al (Al.!; — C�� 71 Y2 <br /> WS, - S0 <br /> MEL-I) ata <br /> Special Instructions/Comments: Relinquished b Recei da bby.. Sample Receipt <br /> N <br /> Sign Sign Total no.of containers: <br /> Print Print Chain of custody seals: <br /> Company, Company C-e-LC_I Recd.In good condition/cold: <br /> Company <br /> Time %G4, Date Time Data` <br /> Conforms to record: <br /> Relinquished by: Received by: <br /> Sign Sign Client: . Alan <br /> Print Print <br /> Company Company Client Contact: Y.-A, <br /> Time Date Time Date. Client Phone:6-/O:;7,f <br /> Date: 7z Page-LLof <br />