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Chain-of Custody Number: <br /> SECOR Chain-of Custody Record <br /> Field Office: 6) QAdditional documents are attached, and area part of this Record. <br /> Address: <br /> r 3 fi Job Name: !! e 61"1 L,oe�Ceor d <br /> n a Location: q'000 4�5 w <br /> e-Fe ee <br /> r LOC off. Analysis Request <br /> Project# �7l�d -o of Q r/ Task# <br /> Project Manage A 9' e-- <br /> Laboratory <br /> Laboratory 127 <br /> Turnaround Time c x �, <br /> c3 o <br /> x Vic? acn S <br /> Sampler's Name �� o,� o , o r <br /> Sampler's Signature f ' -- -• c , � 3 r H <br /> z w x E 'h � Comments/ <br /> Sample ID Date Time Matrix _ m m z �1 AR a Instructions $ <br /> 0' o 7'1 6 i L .5 d 9 �o <br /> S r -fG L -12 S p <br /> tit,w -Sr 'oo _01 a. <br /> M M1.5-- .90 fi <br /> 14 w <br /> L ? <br /> Special Instructions/Comments: Relinquished by: Rece'v d by: d Sample Receipt <br /> Slgn. Sign Total no.of containers: <br /> Print raw n Printz Chain of custody seals: <br /> �u L fh��l2 �TlG Company o Company 17-7 .e Rec'd.In good conditlon/cold: <br /> Time r0 a.. Date Time IaN7baie�-q6Conforms to record: <br /> Relinquished by: Received by: <br /> Sign Sign <br /> Client: <br /> Print Print <br /> Company Company Client Contact• «^ <br /> Time Date Time Date Client Phone�7e <br /> SECOR CUSTREC F tov.1M <br /> Date: 7 / <br /> _ _ --_--- . _ - ----- <br />