Laserfiche WebLink
0069 <br /> CHAIN OF CUSTODY No. 100191 Page-\ of� <br /> CONSULTANTS(141\` `f <br /> NAME �v CONSULTANT'S ADDRESS <br /> a.�i►+�� a �i�t�Z 0%0 „O OS t+ <br /> BP SITE NUMBER BP SITE/FACILITY ADDRESS CONSULTANT PROJECT NUMBER <br /> `\tiei.S 0 3Z.-ss L.�'�\..ro "1"9" 3�' �("1 <br /> CONSULTANT PROJECT MANGER PHONE NUMBER FAX NUMBER CONSULTANT CONTRACT NUMBER <br /> BP CONTACT BP ADDRESS PHONE NUMBER FAX NO- <br /> LAB CONTACT LABORATORY ADDRESS PHONE NUMBER FAX NO. <br /> SP CONTACT REQUESTING RUSH TAT(Print BP Contact Name) RUSH REQUESTED OF(Print Consultant Contact Name) DATE/TIME SHIPMENT DATE SHIPMENT METHOD <br /> 7A7: F124 Hours M 48 Hours E] 72 Hours X Standard 7 or 14 Days ANALYSIS REQUIRED AIRBILL NUM <br /> CONTAINERS PRESERVATIVE o B <br /> 4f 10 <br /> SAMPLE DESCRIPTION COLLECTION COLLECTION MATRIX <br /> GATE TIME SOIUWATER NO TYPE LAB �/ COMMENTS <br /> (VOL.) SAMPLE# r <br /> }r x <br /> x x x <br /> •moo w 3 ,{ -Ac x <br /> x > <br /> 0 <br /> SAMPLED BY(Please Print Name) SAMPLED BY(Signature) ADDITIONAL COMMENTS <br /> RELINQUISHED BY/AFFILIATION LATE TIME ACetffflD BY/AFFILIATION DATE TIME <br /> (Print Name/Signature) (Print Name 1 Signature) <br /> U4a <br /> PC /-5 99 I o ori <br /> CLV-16722-A(2197) <br /> PKGI5O DISTRIBUTION WHITE-OflIGINAL(WITH DATA) YELLOW-BP FINK-LAB BLUE-CONSULTANT FIELD STAFF <br />