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L)u <br /> Chain-of Custod Number <br /> 11 <br /> SECQR Chain-of Custody Record p <br /> Field Office a �7 �I Additional documents are attached, alnd are a part of this Record <br /> Address c� 7'[: /dd II Job Name <br /> Location l YA2�) <br /> j <br /> Project#4977 Yl 72��%sk# <br /> 11 Analysis Request 11 <br /> Project Manager <br /> Laboratory <br /> Turnaround Time _ a (O m <br /> U ma m1 9 U CO <br /> Sampler's Name 5± -5 t m <br /> ° ° i �ac� a� ° mw (U CL <br /> Sampler's Signature -abcv m m �� W w aa QoQ� m� pva <br /> Comments/d d o cmoSam le ID ime CO1,- a w (o a w c°a <br /> Instructions z <br /> C t <br /> I 11 <br /> 11 <br /> j 11 <br /> 11 <br /> II <br /> 11 <br /> 11 <br /> 11 <br /> II <br /> Special Instructions/Comments Relinquish ! Received by 11 Sample Receipt_ <br /> SignSign total no of containers <br /> pp r1 <br /> Tleg s c-�•� 1'esv [i's -�-� Print Print Chain of custody seals <br /> Com <br /> A9. �� � T'�j ��e% � �'6/-o Y3o Time pany 115`� ate T me L y Y s' s ate Recd ir ,good condition/cold <br /> 11 Conforms to record <br /> Relinquished b Rece=�� <br /> li <br /> Sign Sign <br /> ]Tient ���/ <br /> Print �� •� oma'^ Print Client Contact�� <br /> Company_11,4e ooA CompC� GI✓� 11 <br /> Time /0*A _ Date Time Date 2 _—ONX, Phone 3�Ird 54LY- w <br /> sEooa cusnaM Rw 2M 11 <br /> Date 2,/ .- /12z_ Pag*— of ? <br /> 11 - <br />