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i ! • <br /> Chain-of Custody Number <br /> SECOR Chain-of Custody Record S(:) \ 6 <br /> Field Office U Additional documents are attached, and are a part of this Record <br /> Address 7 O 0�du Job Name _ <br /> 1,?Awt 4,0 Ir-0,(00.V,/. Location -Z 3S1 <br /> t u E~�C rc <br /> Protect# •rxwdik# <br /> Analysis Request <br /> Project Manager r <br /> Laboratory Kul a „ ■, <br /> Turnaround Timew �,r i <br /> IL 2 82 m iu c ? <br /> 0.0 <br /> e <br /> Sampler's Name .� rr,■� z D e g m" m <br /> a o UN O0 m0 00 0 av m <br /> Samplers Signature m E m o m a 0 s a 0 2 <br /> Sample 1D Date Time MaVix = m a o >m = a$ a i' Comments/ <br /> z <br /> oe i <br /> �i o2 i <br /> oe <br /> Special Instructions/Comments Relinqu Received by Sample Receipt <br /> Sig Sign Total no of containers <br /> Prin Print Chain of custody seals <br /> Company SLG Compan Recd in good condition/cold <br /> Time Date T Date Conforms to record <br /> Relinquished by ReceivedClient C.)Sign Sign- J- <br /> Pnnt Print WC661E tWeL-k1Wa0-- ClientContact:5�rr <br /> Company Companyl-kq XJ4k,a:�l <br /> Tim Date Time 111T_ `Date 12.056-x_ Client Phone 961-G crw <br /> 1111 CUSTREc a"2M <br /> Date /7-/ �� / ��- Page�of <br />