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Chain-of Custody Number r <br /> SECT Chain-of Custody Record <br /> Field Office -?-7-�,�CJH 7�'�y�Jt�. E3 Additional documents are attached, and are a part of this RArd <br /> Address ,0 1 '7 K1Job Name <br /> CA_��yg QS�a 7a Location <br /> 7 <br /> Protect#-0'77, 3M Task# Analysis Request <br /> Protect Manager TT EF / wAt-crWn.ZP� <br /> Laboratory lc, �`� <br /> Tumaround Time a m o 6 .� <br /> Sampler's Nam $ (L g m a o too o n m n° <br /> Sampler's Sigrratu E N °>N -8- <br /> 3: ,m <br /> m �` nc�`p 'a o%� d k E <br /> Sample ID Date Time Matrix = i w a)o a°o ►°R a` Instructions vt s z <br /> o X <br /> Special Instructions/Comments Relinquished by: Received by Sam le Receipt <br /> Sign Total no of oontainem <br /> Pnnf�.woA. Wl wo o c_L.. Print Chain of custody seals <br /> Company co Company Recd n good condition/cold <br /> Time i�' 3�{ Date 1"`I"�i T Date <br /> Conforms to record <br /> Relinquished by Received by Client <br /> Sign Sign <br /> Print PrintTC�t. 'lt5T 1� Client Contact <br /> Com Company;�P_A 1(CAL <br /> T Date Time+. 4� Datecai�o 1 Client Phone <br /> SE"arc%V Vs <br /> Date / I l0 L-_ Page -,-7 of Z_ <br />