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fi <br /> CHAIN OF CUSTODY NO.Q 5 3 016 Page of <br /> CONS U TA;TS NAME ADDRESS CL <br /> STATE Z1P CODE <br /> BPS NUMBER BP ORNER AE2gE CITY CONSULTANT PROJECT NUMBER <br /> CONSULTANT P JEC MANA R PHONE NUMBER FAX NUMBER epCONSULTANT CO R CT NU ABER <br /> BP CONTACT BP ADDRESS PHONE NUMBER FAX NO <br /> LAB CONTACT LABORATORY AODR SS PHONE NUMBER FAX NO <br /> SAMPLED BY IPlea Pn ame) SAMPLED BY ignature) SHIPMENT DATE SHIPME ,METHOD <br /> TAT: o 24 Hours 48 Hours f Wee Standard 2 Weeks ANALYSIS REQUIRED AIRBILL NUMBER <br /> COLLECTION CONTAINERS PRESERVATIVE '9 <br /> SAMPLE DESCRIPTION D'A'TE MATRIX � <br /> SOIU+fATER TYPE LAB COMMENTS <br /> COLLECTIONVOL. <br /> TIME NO' (VOL.) SAMPLE# <br /> Rd 17 <br /> 7-9 <br /> r <br /> 7 D <br /> RELINQUISHED BY/ FFILIATION DATE TIME ACCEPTED BY!AFFILIATION GATE TIME ADDITIONAL COMMENTS <br /> OLV-16722 Distribution: White-Original(with Data) Pink-Lab <br /> Yellow-BP Blue-Consultant Field Staff u <br />