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of <br /> Chain of Custodtecord -site 5 to 'time_ Temp <br /> bp Project Name [MomorolpEcal <br /> "site T'uac Temp <br /> Bl'MUM CO Portfulio: 7 <br /> BIS Lal rtttnry Contruct Numbur: E s <br /> Date: d-- 2 Q Z Requested Due Date(mm/dd/yy) 7- /2 h O Z td S t�ir+ ori <br /> Send To: P/GEM Facility No rPIGIEM <br /> ant/Contractor f <br /> Lab Name P P/GEM Facility Address i D t yof r DO <br /> Lab Address Site ID No d z rd 4 <br /> tte Lat/Long IDD p <br /> alifotnia Global ID is O O aaUContractorPro ect o pp <br /> Lab PM P/GEM PM Contact v aat/Coutractor fele/Fax /f �t1 O <br /> Tc1rJFax ss 6.5-V42' antlContractor RM vgv <br /> Report T &QC Level p to ComWtaat/Contractor Plrom Circle one) <br /> BP/GEM Account No elt/Fax 2 S^ - Wort Release No <br /> Z� B � <br /> Lab Bottle Order No Matrix Preservatives Regnetted Analysis <br /> T <br /> Item y N x o Sample Point 1AVLong and <br /> Sample Description Time � .a <br /> IUoratory No. o � � <br /> No g oo N Comments <br /> 1 lo;10 B <br /> 2 M 0 10:ze 176 1 <br /> J bA4 W-3- 6.57 <br /> a VM W o ' r6 3 0 <br /> s w- o �a9 1 1 1 16 X <br /> 6 �3 6 so 11 1 1 x <br /> 8 <br /> 9 <br /> la <br /> Sampler's Name r P n G R.tiny,ui be tioa to IIThw ped W AfMsdmItrbw <br /> Sampler's Cog!!y <br /> Shipment Date 6 -Z O Z <br /> Sht trent Method- 'vr <br /> Shipment Tracking No <br /> Special Instructions, <br /> Custody Seals In Place Yes No Temperature Blank Yes No Cooler Temperature on Receipt °F/C Trip Blank Yes No <br /> lAB ATORY W COC Rev 1 2)SM2 <br />