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Chain-of Custody Number r6ML-J) <br /> SECOR Chain-of Custody Record <br /> Field Office 7 0 Additional documents are attached, and are a part of this Record <br /> Address w�or* d� Job Name / � <br /> Location D W $g <br /> 1 T - <br /> Project# M-77. 41737,Wi Task# Analysis Request <br /> Project Man ager 4WN <br /> Laboratory o y <br /> Q m <br /> Turnaround Time N in �; M a <br /> 0U U �° <br /> Oks <br /> Sampler's Name �� o C o a °i� o o r31 <br /> z o <br /> ' m £ E m vN oa c or- vas <br /> Samplers Signature o �,�, �, m °' o m 'm m _�_ Y a <br /> =r S.- S oN n51 E�5 NW �N O" J E <br /> V d6 d0 (L 20 ON ro0 mN d0 Oa �- � Comments/ <br /> Sample ID Date Time Matrix z c m a to �( _� N o rl� �- n.2 Instructions z <br /> Q' o ro5'6 cu p 4 a (p <br /> %p 3AV< 0 f---Q I �z <br /> vU- S o 010 1 ( R6 9 <br /> WI zas, lw o 01011 <br /> w'10 12>05 n 01011 <br /> jqw-z 1;340 D 0 10 a <br /> MW-1 1 15 0 <br /> MAW- 5 1456 W o ! a Le q <br /> Special Instructions/Comments Relin ish d Received by Sample Receipt <br /> Sign Sign Total no of containers <br /> Print U Print Chain of custody seals <br /> Compan Company Rec'd in good condition/cold <br /> Time Date 4f Time Date Conforms to record <br /> Relinquished by Received b . ,4Client oR <br /> Sign Sign� � . "WAV" , _P�Lu <br /> Print Print Client Contact <br /> Company Company (,nJ <br /> Time Date Time/0 y!5:__ Date l•{ Client Phone <br /> LI <br /> SECOH CUSTREC Fev 2rBS <br /> Date d / 2L—) / C) Page L of <br />