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5494 • Chain-of Custody Number • <br /> SECOR Chain-of Custody Record <br /> Field Office SAS aur M3 Additional documents are attached, and are a part of this Record <br /> Address 1-734 S 1 T4 - �T „._ Job Name (Ni oc U <br /> S CA 9 5191 Location 570Q<T4AJ <br /> 916 s& -4.333 FA)( CQ)b 4S6-0rto <br /> Project#PJ 0106— 06'9-0 Task# Analysis Request <br /> Project Manager —TONti! SOWS <br /> Laboratory <br /> Turnaround Time _. _S2AuDA tZb _ a o <br /> C0 :R 06 m o <br /> Sampler's Name S=74 .. $ w e O c is a io o m <br /> Sampler's Signature a E m o m W $,m � v '�' 4 E <br /> U C o 0-0 a o o N �o D woo o v ° U Comments/ z <br /> Sample ID Date Time Matrix z co m �- ¢m w x co W m a to F n ci M F Instructions <br /> f'1,1 W 30 5 1.140 <br /> 3 <br /> rum �$ t4Sb 3 <br /> IZZ <br /> 111U.1 L� f�57 <br /> Special Instructions/Comments Relinquishe by Received by Sample Receipt <br /> Sign Sign Total no of containers �Z <br /> Print /3 AIZ4 Print Chain of custody seals <br /> Company S6'UX Company Rec'd ,n good condition/cold <br /> Time Date S -$ Time Date Conforms to record <br /> Relinquished Received by <br /> Sign Sign Client <br /> Print Print Seo ?, keri'Main� <br /> Client Contact <br /> Company Company T�L-- <br /> Time Dat Time 0 50_A-/? Date2j�j Client Phone <br /> SECORCUSTRECRev 1B5 <br /> ICA, +�-��'', 3 v 6$ W i e,4,(, Date s ��_Pag e__k_of <br /> If C-0—1 c t— w <br /> L , 1 0 -tom <br />