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age of <br /> Chain of Custodoecord On-site Time Temp <br /> iu b <br /> Project Name _hyG EV V Off-site Time Temp <br /> BP BU/GEM CO Portfolio: Sky Conditions <br /> BP Laboratory Contract Number Meteorological Events <br /> ' :-�2 Requested Due Date(mm/dd/yy) "yi vial. �,,�' Wind Speed Direction <br /> Send To. BP/GEM Facility No r r ,�, Consultant/Contractor <br /> Lab Name � . Address i 'y � <br /> Lab Address Site ID No `3 i ,. t z -fv <br /> c�sr Site Lat/I.ong e-mail EDD <br /> California Global ID# ObV 2-7 i,2(, 3Y Consultant/Contractor Project No L/ <br /> Lab PMBP/GEM PM Contact .—J FConsultant/Contractor Tele/Fax .13i,' <br /> Tele/Fax AddressConsultant/Contractor PM 0f JJ VA;,:,,,, <br /> Report Type&QC Level Invoice to Consultant/Contractor or BP/GEM (Circle one) <br /> BP/GEM Account NoTele/Fax P/GEM Work Release No �'/j< .C j:./ <br /> Lab Bottle Order No Matrix Preservatives Requested Analysis <br /> 75 <br /> Item Sample Description Time ,n3Q Laboratory No w O <br /> 0 x <br /> On <br /> ' Sample Point Lat/L <br /> ong and <br /> 3 No o � ry Comments <br /> � 00 OQ <br /> O <br /> �� <br /> a z �D z ►d 4 <br /> 2 <br /> 3 ti* <br /> 5 � � <br /> 614 <br /> 9 Z15 <br /> 10 '' i n r , <br /> f <br /> Sampler's Name !S Reltnqui d By/llti'llta.Rodf s triL <br /> Date ime ccepted By!Aation Date Time <br /> Sampler's Company '),r' .� - ` r ,` i F''°r ' 1 ,1�r ;f s3 <br /> Shipment Date t v, <br /> Shipment Method <br /> Shipment Tracking No <br /> Special Instructions <br /> Custody Seals ki Place Yes o Temperature Blank Yes NoCooler Temperature on Receipt °F/C Trip Blank Yes No <br /> U A ! A BP COC Rev t 2/5102 <br />