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• 0 Chain-of Custody <br /> SECQR Chain-of Custody Record C 604011) � <br /> Field Office '077 0 Additional documents are attached, and are a part of this Record <br /> Address 39/7 p /4 d ��� -- �� Job Name T 00,,e--d: <br /> Location I!JL4G <br /> Project# �7o r '5e-173 -7 Task#© � Analysis Request <br /> 1 <br /> Project Manager `7_n4pge <br /> Laboratory 6xc�+J��I�m/ <br /> �J/ O'✓ �'G/ Z6 ° <br /> N m t C <br /> Turnaround Time H � � a � <br /> y is c� -3 QU V :° <br /> 2 ca m a m <br /> Sampler's Name �� ^ o a $ 21 c a v o M m o <br /> m E E 00 °��" VIt C� o� °'� m a` <br /> Sampler's Signatur o �,�, �, m� o 'o a m a <br /> V ao ao a °o oOJ Co Wcli 2 E mo o� m �j Comments) a <br /> 00 <br /> Sample ID Date me Matrix s � W W c _w COCO a w a Instructions z <br /> Z,� 1 ,'r J b <br /> Special Instructions/Comments Relinq s Received by <br /> Sample Recei t <br /> S1 g Sign Total no of containers <br /> Print Print `W Chain of custody seals <br /> Compa =gtb � Company Rec'd in good condition/cold <br /> Time e ny -� Date A TimeDate Conforms to record <br /> Relinquished by Received by Client <br /> Sign Sign <br /> Print Print Client Contact <br /> Company Company <br /> Time Date Time Date Client Phone <br /> SECOR CUSMEC Rev 2M <br /> Date I I Page of <br />