Laserfiche WebLink
CHAIN OF CUSTODY NO- 100737 Page—Of <br /> CONSU�SNAME CONSULTA�F� <br /> DRE55 <br /> jjqcf :,d- ov.(,4 C� <br /> BP SIT NUMBER BP SITE/FACILITY ADDRESS CONSULTANT PROJECT NUMBER <br /> CO LTANT PRO C MANGER PHONE NUMBER FAX NUMBER CONSULTANT CONTRACT NUMBER <br /> 4 w43 54 �)o 331211,,w d `f <br /> BP ONTACT BP ADDRESS PHONE NUMBER FAX NO <br /> Kit <br /> LAB, NTACT LABORATORY ADDRESS11- C11 PHONE NUMBER FAX NO <br /> BP CONTACT REQUESTING RUSH TAT(Print BP Contact Name) RUSH REQUESTED OF(Print C sultant Contact Name) DATEITIME SHIPMENT DATE SHIPMEINJT METHOD <br /> AI ILL NU BER <br /> TAT 24 Hours 48 Hours 72 Hours Standard 7 or 14 Days ANALYSIS REOVIRED <br /> CONTAINERS PRESERVATIVE rr✓✓ <br /> SAMPLE DESCRIPTION COLLECTION COLLECTION MATRIX COMMENTS <br /> DATE TIME SOIL/WATER NO TYPE LAB `� � i <br /> (VOL) SAMPLE# [Vs�► <br /> f -zep 5z% 5d vu <br /> • ,57 <br /> I <br /> 7 L { <br /> aL/ <br /> SAMPLED BY Please Print Name SA D BY( Ign ture) ADDITIONAL COMMENTS <br /> RELINQUISH11D BY/AFFILIATION ACCEPTWY/AFFILIATION <br /> (Print Name/Signature) DATE TIME (Print Na e/Signature) DATE TIME u <br /> I01pU0 <br /> CLV 16722 A(2/97) <br /> PKG/50 DISTRIBUTION WHITE ORIGINAL(WITH DATA) YELLOW BP PINK LAB BLUE CONSULTANT FIELD STAFF <br />