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i <br /> Cham-of Custod Number �5 2(� <br /> SECOR Chain-of Custody Record <br /> Field Offloe 077 0 Additional documents are attached,and are a part of this Record <br /> Address 3017 �� l Job Name -7-C> t " 3a�b a <br /> 76 Location a i1111 ��ip <br /> r <br /> Prmlect#-27 .. S) 0 f Task#_0 6a 3 Analysis Request <br /> Project Manager r� <br /> Laboratory. UCCO <br /> W p <br /> Turnaround Time <br /> e� <br /> m a a I 4� m m c <br /> Sampler's Name a E � m� a <br /> Sampler's Signature .20 00 V m o o a o <br /> N P N <br /> US TLO <br /> Sam S � `� omffE <br /> pie 10Date Time Matnz <br /> Comments/ <br /> a E <br /> z <br /> W-1 l 1.6 `% <br /> V oil Ix 1 —OIL <br /> 6 to;W -03 <br /> M��a lc7 lob to-T4 <br /> Mv�9_a i ► 1 to: <br /> o >b K"131 V <br /> �tv <br /> Special Instructio s/Comments Relinquis ed by R n ed by Sample Recei t <br /> Sign Sign Total no of containers <br /> Print r Print Cham of custody seals <br /> Company sit-Mr Compa Rec'd in good condition/cold <br /> Time 1 !? Date 7 T Date <br /> Conforms to record <br /> Re i shed by Received by Client <br /> Sign Sign ' ..., <br /> Print Print Lr A 4. Client Contact <br /> Company CompanySR=CU97MC P-2W <br /> T Date -rime Client Phone <br /> Date / 1 / (�3 page_Lof <br />