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s <br /> Chain-of Custod Number • <br /> SECOR Chain-of Custody Record <br /> Field Office -7 -7 �&uo,fin o Additional documents are attached, and are a part of this Record <br /> Address 31� ►'�L , ��� CC� 7" C ( �1E �Job e <br /> Location A <br /> �JC <br /> Project# Task# G' U Analysis Request <br /> Project Manager s � I <br /> Laboratory t M ��Turnaround Tame ' P r o e m c <br /> IL <br /> Sampler's Name 1\ <br /> ano <br /> a <br /> r o COpmSampler's Signature °i <br /> o m N v oN Q <br /> E a <br /> e ID ` <br /> co toCD0Sam TiMatrix r- a� a <br /> Comments/ E <br /> Instructions z <br /> M('— i )o t7 t::�'SC �c"° <br /> t'KV7_ 1v +7 w, 53 I <br /> UP'lC�- 1 Eta i`7 tu-55' <br /> � � l <br /> Special Instructions/Comments Relinquished by keeeived by Sample Receipt <br /> Sign Sig i- y Total no of containers <br /> Print r -A\W Print O - s <br /> Chain of custody seats <br /> Company 5e f'r Com an - <br /> p y� Rec'd in good condition/cold <br /> LTime �a � Date ►t- �'� L� Tarte Date_ � <br /> Conforms to record <br /> RI'Irri_quished by _ �'F Received by Client <br /> Sign Sign <br /> Print 'f - <br /> Print - - - Client Contact <br /> Company - Company f ` <br /> Time .- Date 4 Time ' Date- Y' Client Phone <br /> sECOR CUSTREc Rev Z" <br /> Date G' / l / Page Y of <br />