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Pagcl ref L <br /> Chain of Custody Record -site Tuna:' o Temp. <br /> bp <br /> Prof eel Name 57 site Time. 0 Temp: <br /> 0 BP BU1GENI CO Portfolio: sky Conditions: r <br /> DP Laboratory Contract Number: Nteteorological Events: <br /> Date: [I")) R bested Due Date mndd � <br /> cq { dlyy) �.,3a-b � ��. Wud Speed: ]3irCction: <br /> Scnd To: RFIGI2hi T'acility Teo•: -260 ',onsuitantl(onlractar: 3��4 cts ��J <br /> Lab Name: „ o " PIGEM Facility Address: 2;Z,,,,d' C{�+a o#�',�" ,1, C,,, Address- ,3 33fl Ca.w d✓e.c PK.Or� �S k l� . �c� <br /> rabAddress: Sift;IT)No. <-- 4, <br /> iteLat/Long: mail lull: 9 a a i Ale <br /> California Global TD ComaullantfContraetor Project NO.: a 7,4 17 <br /> Lab Pit: 1t0 Vt C&6 62 Uffial IM Contact: pd,e...1 ,S w 1 C `onsullant/Contraetor TdOl x: 5D 0 t gVe.-t o s � <br /> relelFax: 9'.1- 7 Addross: 'onsullant/Conlraator PM- <br /> Report Type&QC IMI inwim to: Consutta:it/Contractor or BPlCEM (Circic one) <br /> BPAUM Aeeount No.: eldFax: PIGEM Work Release No: <br /> Lab Bottic Ordcr No: hialrix Preservatives Rtvlaested Analysis <br /> b <br /> Item } ry o .�. Sample Point Lot/Long and <br /> Samt to Descrlpi[on Time Laboratory\o. a ?p y <br /> No. o 0° rr oca CSaroments <br /> co <br /> PQ <br /> l Si�1�1 T. SPS- V &191b y K X1 K 4 a►% HS <br /> SPI-sTo,fP/-'S of - 7C r X k 4,a-H e. % wry <br /> 4z4 <br /> s - � WIT- x x k <br /> 7 ri YS ) K K <br /> $ -2- 3.r 1132 <br /> 9 <br /> toll <br /> SRllllslcr!shlanle: ae' By Tlax atp[ktd By/A(fidWiotL <br /> Sampler's Compafny: tA. $ <br /> Sh�gnlcni llate: - , <br /> Shipment Mclhod, , Y <br /> Shipment Tracking NQ: <br /> Spedal InLtruciiont: <br /> Custody Seals W Aacc Ys No Temperature Blank Yes No Cooler TumpmIum on Rcceipt oxc- Trip Blank Yes No <br /> LABORATORY BP COC Vey.1 2f5,,1U2 <br /> ti ti � � ri ti ti ti ti ti ttttttttti ti ti ti ti ti � i ttttttttti <br />