Laserfiche WebLink
0 <br /> . . 4. i . <br /> CHAIN OF CUSTODY NO.O 6 310 0 1 Page_L of <br /> CONSULTANT'S M ADDRESS CITY STATE ZIP CODE <br /> Ino <br /> BP SITE NUMBERP CORNER ADDRESSICITY ` CONSULTANT PROJECT NUMBE <br /> L rb `D ' � 0 <br /> CONSULT PROJECT MA GER PHONE N 1Eo — I FAX N ER xte"u <br /> TACT NUMB R <br /> SP CONTACT BP ADDRESS PHONE NUMBER FAX NO <br /> l� <br /> LAB CONTACT LABORATORY AD RE55 I PH NE NUMBER FAX NO <br /> Ors - �O oD $ - 3 <br /> SAMPLED BY(Please Pnn Name) SAMPLED BY(Signature) SHIPMENT DATE SHIPME T METHOD <br /> f <br /> 1� <br /> AIRBILL NUMBER <br /> TAT: ❑ 24 Hours ❑ 48 Hours ❑ 1 Week ❑ Standard 2 Weeks ANALYSIS REQUIRED <br /> COLLECTION CONTAINERS PRESERVATIVE <br /> SAMPLE DESCRIPTION DATE MATRIX COMMENTS <br /> SOILIWATER TYPE LAB <br /> COLLECTION <br /> TIME NO, (VOL.) SAMPLE# <br /> F <br /> ADDITIONAL COMMENTS <br /> RELINQUISHED BY/AFFILIATION DATE TIME CCEPT D BY/AL1ATlON DATE TIME <br /> A. <br /> 1.7 <br /> Cl V 16722 Distribution: White-Original(with Data) Pink-Lab <br /> Yellow-BP Blue-Consultant Field Staff <br />