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Cham-of Custody Number• <br /> SECOR Chain-of Custody Record <br /> Field Office Additional documents are attached, and are a part of this Record <br /> Address U Job Name <br /> { <br /> f` l �G -7r ) Location -7 <br /> b <br /> Project#. 7220-t `'�.��,�22,U l Task# CV/0 Analysis Request <br /> � <br /> Project Manager <br /> Laboratory k kg <br /> Turnaround Time f:j) �, �, `-' co C <br /> m Samplers Name w o o o co <br /> Sampler's Signature F <br /> m o <br /> °C, m Y N a <br /> v a a o a °0 9 NM o m N d o o v = Comments/ <br /> Sample ID Date Time Matrix = I9 F--coi- a 0 c Z w u)(D a m h-r, 0-2 Instructions z <br /> �f/)� lv-r�•Ly 2 �ca /7�r � <br /> Special Instructions/Comments Relinquished b Received by Sample Receipt <br /> Sign - Sign Total no of containers <br /> Print 1U a v% �f' Print Chain of custody seals <br /> Company ' Comp <br /> Time Recd m good condition/cold <br /> ��Date 1 e Date <br /> Conforms to record <br /> Relinquished by Received by Client r~ <br /> Sign Sign v Z� <br /> Print Print Client Contact <br /> Comp Company.V;IeF ;7tJA"T-_r-x-AL <br /> e Date Time Date to-i�-o� Client Phone <br /> SECOR CUSMEc Rei+2198 <br /> Date ZI i l ;r Page of <br />