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Chain-of Custody NuMber <br /> SECOR Chaim-of Custody Record <br /> A h <br /> r,a r t ST c3 Additional documents are.attaehed, and are a part of this Record: <br /> Field Office: <br /> Address: fo p y No w i v r�+,,1., S `4 e e�� .lob Name: ! <br /> H mala f%S Td j1 Location: S <br /> Project#FAQ 10- 0/LV 3 Task# Analysis Ruest <br /> Project Mana er `�� 0�i eW <br /> f/ T <br /> Laboratory- <br /> Turnaround <br /> aboratoryTurnaround Time m <br /> ' EH, <br /> Samplers Name / P H a o m c��i o tj o c3 CE <br /> M o m o td r <br /> Sampler's Signatur z m g w -2 n i� E <br /> c3 a-o aoo _ aa F=55 a Comments/ z' <br /> Ig Sample-ID Date. Time Matrix - flo a> r ¢ r m a r-A 2 Instructions <br /> l ? <br /> JI►- 2 <br /> tAw" Q r . <br /> . <br /> 7 57 <br /> Special Instrus/Commen : Relinquishe Rece' Sample Receipt <br /> y <br /> qQI7 .. dig Total no:of containers:tt1 pdnt,?4*,,/..r- t, 00 Print Cham of custody seals:_ <br /> r1s" t; Z.Tii Company ittJ Corrtpan Recd.in'go od.condition/cold::_ <br /> Time • Datef �' �. Tme I Date b Conforms to record: <br /> Relinquished by: Received by: <br /> Sign Sign Client: <br /> Print Print Client:Contact: <br /> -Company Company x <br /> Time Date Tore Date. Client`Phone. <br /> SECOR CUGMECRw.7l95 - - - <br /> -F page . of <br /> Date: i ~ <br />