Laserfiche WebLink
i <br /> • s <br /> i f <br /> CHAIN OF CUSTODY NO-053026 Page Of <br /> ODE <br /> CONSUL NT'S N E ADD ESS CITY S TE IP C <br /> 4 � <br /> � <br /> BP SIT NUMBER 1 BPC RNER ADDRESS/CITY CONSULTANT PROJECT NUMBER <br /> CONSULTANT P JECT MANA R PHONE BER FAX NUM ER CONSULTANT CONTRACT N SER <br /> BP CONTACT � � � BP ADDRESS � � PHONE NUMBER FAX NO. <br /> C� c <br /> LAB CONTACT n LABORATORY ADDRESS PHO E NUMBER FAX NO. <br /> Ylit)OtAl) S g_ oo 723 � 3 <br /> SAM P ED BY{Please Name SAMPLED BY(Sig ure) SHIPMENT DATE SHIP EN7 MT <br /> PAAL U 6 er <br /> AIRBILL NUMBER <br /> TAT: ❑ 24 Hours ❑ 48 Hours ❑ 1 Week tandard 2 Weeks ANALYSIS REQUIRED <br /> COLLECTION CONTAINERS PRESERVATIVE <br /> SAMPLE DESCRIPTION DATE MATRIX LAB COMMENTS <br /> TYPE 2 <br /> COLLECTION NO. SAMPLE# <br /> SOIUWATER b-- <br /> TIME � y '{) I <br /> z <br /> 3f�3o�2 <br /> tl <br /> — 3G 3aS <br /> ADDITIONAL COMMENTS <br /> RELINQUISHED BY 1 AFFI IATION DATE TIME ACCEPTED BY!AFFILIATION DA/E TIME <br /> rill <br /> trd'ULF2,1 wQ- j <br /> CI V 16722 Distribution: White-Original(with Data) Pink-Lab <br /> Yellow-BP Blue-Consultant Field Staff <br />