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I <br /> r <br /> II Cham-of Custody Number <br /> SECOR I Chain-of Custody Record <br /> Field Office i Q Additional documents are attached, and are a part of this Record <br /> 7 rr, <br /> Address Job� � I� I Job Name „ - J• •{ /; F< fi <br /> Location <br /> Analysis Request <br /> Project#7 7 r G 7e d*# , <br /> Project Manager <br /> Laboratory 6l F o N q <br /> U G1 <br /> Tumaround Time S7/'•� �/rte a fT on U) m u� <br /> �o ❑a a m Ng co <br /> c <br /> � 2 ' p 100 a m� d 7 N U <br /> Sampler's Name G. ��" f.r�t.r�- / a a o �'" 7u a o M :9 0 <br /> i mE E CO "N Oa c6 o mm ro aV <br /> Samplers Signature r-� -- - --- m N °' 'N N <br /> U a o o la °o o N CC o m N m°Do o a m U Comments/ <br /> Sample ID Date Time Matrix s p ml m iH Q m �0 2 cn cn ca a co F ti d 2 H Instructions Z <br /> r <br /> II <br /> I If <br /> � II <br /> t IC <br /> C II <br /> I II <br /> � I <br /> Special instructions/Comments Relmgwshed a Received by Sample Receipt <br /> SignSign Total no of containers <br /> fl�`"'1��C I <br /> Print Print_ � � Print�/ Cham of custody seals <br /> Company e t 4`f _ Compan Rec'd in good condition/cold <br /> Time Date Date Conforms to record <br /> Relinquished by eceived by �•-•-- Client � ey <br /> Sin f I Sr r' f .l y <br /> Sign n g <br /> „ = <br /> Print f Print Client Contact <br /> Company_-� Company <br /> Trine` 2� �G Date Time Date - Client Phone �{U <br /> SEcoR CUSTAEC Rev.2M r <br /> G <br /> . Date / f / Pagilof <br /> it <br />