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Chain-of Custody Number <br /> SECQR Chain-of Custody Record JO ao 3� <br /> Field Office ,'7 �I Additional documents are attached, land are a part of this Record <br /> ��a�71�• � � �� S'� !� Job Name II .-+, ' �,' I L�2c 'ar� <br /> Address _ <br /> Location j IV aAn 4 h -i rk <br /> II II <br /> Project 02/7 J:z? '--�-'Task# II Analysis Request II <br /> Project Manager_N)vh" <br /> Laboratory o W m <br /> Turnaround TimeN - <br /> °m a is c�7 o V U « <br /> z� o mU v d a y U <br /> °0 � B'M "a 0 °coSampler's Name °o Q m <br /> E oti gaom Sampler's Si natum <br /> o <br /> H m o a m Comments/ <br /> U n-o as r1 20 oa �o (Dcv mo <br /> Sample ID Date Time atnx � a > _(0 CO w a t r- a` Instructions z <br /> 6 i 3aJ II 6� x. 114 <br /> !I II <br />� II II <br />' II II <br /> II II <br /> II II <br /> II II <br /> II II i <br /> Special Instructions/Comments Relinquish° by Rece d by II Sample Receipt <br /> Sign Sign R a.� Total no of containers <br /> Print ` -Print Chain of custody seals <br /> Company ?� �f' CompanyE4D Reed in good condition/cold <br /> Time Date---/7&2 Time�L(Date n� o Z <br /> ii Conforms to record <br /> Rehn uishled by Received by Client <br /> Sign C II Sign I�'1rrtG+Pr� c'�2�_ <br /> Print i� �t Print Mfn (Client Contacts <br /> Company 11 Z Company e <br /> Time I ZI 3 Date°3 o Time 1 Z:33�_ Date 0 3 07 !Client Phone <br /> SEtOR(XW <br /> Date -� / �' / ����- P� of <br />