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�N& <br /> Chain-of Cu ber <br /> SECQR Chain-of Custody Record �0, 00() -7 � <br /> Field Office 07 I 0 Additional documents are attached, and are a part of this Re�rd <br /> Address r'7 – 0 Cdr Job Name ��1_ OIL 1-061936690 <br /> [ GQ VIg- Location <br /> Analysis Request <br /> Project# b 7 37,603 Task# <br /> Project Manager_ ro:( D ft INS <br /> Laboratory rXL EL.Ch4� <br /> Turnaround Time 5771 lrrl oA U _ r cn 21u) <br /> Sampler'wswNa�^m�e U o <br /> po N <br /> '- <br /> 2 <br /> ° <br /> I.- a o o mo m <br /> o ME a i <br /> Sampler's Signature �� N ; ID o om <br /> _ U <br /> 00 CommentsN � a2on <br /> ZSam le ID Date Time Matrix D srui <br /> W-z_ I � r205 w� o to q <br /> 14U- 1 ed 5l 110 O qq <br /> W- (� X35 U) Ito <br /> im W-5. 1 w Ir o 101 <br /> 0 0 ° <br /> 11 1 X015 U) I <br /> w� r r0�5 W. 11 C a l oill <br /> Mw- 315 11 o10 <br /> W- tv ►� of o <br /> tie --- 11 <br /> pedal Instructions/Comm n s Relinq he by Received Sample Receipt <br /> Sign Sign Total no of containers <br /> FA ( �7� T–t) Print RvPW1 _K ANNU52- Print Chain of custody seals <br /> �1 — WN Company Company Rec'd in good condition/cold <br /> f O p 7 Time_$��Date ^o8-00 Time 11 05 Date Of 4ZT— <br /> Conforms to record <br /> OM Relinquished by Received by Client iG <br /> Sign Sign <br /> Print Print Client Contact—r, Rwq <br /> Company Company <br /> Time Date Time Date Client Phone 9!� o^6r•�� <br /> SECQR CVSTREC Rev 2/95 <br /> Date / / Page_L of L <br />