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low <br /> CHAIN OF CUSTODY N0.084393 page 1 of�" <br /> CONSULTANT'S NAME ADDRESS CITY STATE � ZIP CODE <br /> ('�115 i t 7 ,lil 7-01c <br /> ) l� 1 W 5-97 <br /> BP SITE NUMBER BP ORNER ADDRESSlCITY CONSULTANT PROJECT NUMBER <br /> I q C�m el Q0 1O - 131 _ <br /> .— <br /> CONSULTAI PROJECT MA AGER P O NUMBER FAX NUMBER CONSULTANT CONTRACT NUMBER <br /> Y-;o a a,) 5 rid` 3 IS"79 `-A <br /> BP CONTACT BP ADDRESS PHONE NUMBER r FAX NO. <br /> 4c) - w <br /> LAB CONTACT LABORATORY ADDRESS PHONE NUMBER FAX NO <br /> La r <br /> SAMPLED BY(Plea print Name) SAMPLED B (Signawre SHIPM L T ;� SHIPMENT ETHOD <br /> AIRBILL NUM ER c' <br /> TAT: 24 Hours 48 Hours 1 W ,Standard 2 Weeks .` ANALYSIS REQUIRED ` O t+-1—7 <br /> COLLECTION CONTAINERS PRESERVATIVE a 1 <br /> SAMPLE DESCRIPTION GATE MATRIXSOILNJATER TYPE LAB COMMENTS <br /> COLLECTION <br /> ON NO. (VOL.) SAMPLE# <br /> 1 y ab A 0 <br /> S -Z <br /> 5 -3 i <br /> T 1 <br /> � 1 l <br /> S - <br /> ADDITIONAL COMMENTS <br /> R LINQUISHED BY/AFFffIATION DATE TIME ACCEPTED BY/AFFILIATION DATE TIME <br /> t <br /> [QA/ <br /> CLV 16722 Distribution: White-Original (with Data) Pink- Lab <br /> PKG750 Yellow-BP Blue-Consultant Field Staff <br />