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Cham-of Custody Number <br /> SECOR Chain-of Custody Record ` <br /> Field Office _1) -7 _ _,..,._._ 0 Additional documents are attached, and are a part of this Record <br /> Address 600 A)Y Job Name / <br /> Location 5_ .,e ti )Z r, <br /> Protect# Task#_r— <br /> Analysis Request <br /> Project Manager 2P'4 )ud i(Tz 1(4i_L - <br /> Laboratory (� . - ._ o W m <br /> Turnaround Time—_r_"2k __..._ = H C� <br /> p i9 <br /> 06 <br /> 067 m C} <br /> Samplers Name 20. $ $ 'o iso o o d v, `+ <br /> � v O m m a°O m <br /> Sampler's Signature ' + ,E Q �o ?� m� °� a 0 3 <br /> Sr I'T 2 Eck roa 2� E i in�ro ( e o« C` - E <br /> U Q o a o a o o ni o N W v o D IT °� U �' COmment3/ <br /> Sam le ID Date Time Matrix = 1-Co.�m +- g 0 >to _to MW a( r, M Instructions Z <br /> _92 Ld- <br /> IF <br /> Iko <br /> �- E � <br /> in <br /> y <br /> D5 <br /> Special lnstructlons/Comments Relinquished by Received by Sample Receipt <br /> Sign Total no of containers <br /> Print / Print Chain of custody seals <br /> Company rL Company Recd in good condition/cold <br /> Time zZ Date—LL-0--j_ Time Date Conforms to record <br /> Relinquished by Received by Client .T!�&enrz <br /> Sign Sign &S.44iA 4, ,2w—_ <br /> Print Pnnt.0ad+g 111612fa w, Client Contact <br /> Company Company_L-f-LA�i raf <br /> Tirrmr Date Time_IS,2 2 Date o 72iG of Client Phone z. . ;t, c L)O <br /> SEWS CUMEC Rev 2189 <br /> Date "7 / ?S. _J01 Page I of 2- <br />