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Page-.ofI(-- <br /> Chaim ®f' CU' todOZccord On-site Time rl(, Temp Q <br /> bp Protect Name Lor 4&,rl Q C� Off-site Time Temp <br /> BP BU/GEM CO Portfolio: <br /> p+! /(, �(�� Sky Conditions C1j,i*s.L,_ <br /> 3-zy BP Laboratory Contract Number: eteorologicaI Events <br /> Date- Requested Due Date(mm/dd/yy) Wind Speed Direction <br /> Send To- BP/GEM Facility No klaw Consul tant/Contractor1971--ft,410 <br /> Lab Name BP/GEM Facility Addesst ` f. ddress <br /> Lab Address Aod. 14.0r, zf IF Site ID No &1AW7dw 01 <br /> 4 C14 Site Lai/_,ong --mail EDD CO.Ti <br /> California Global ID# (74! 7 Consultant/Contractor Projectgo- <br /> Lab <br /> PM A=C*g ,L, / BP/GEM PM Contact v Consultant/Contractor Tele/Fax <br /> Tele/Fax • 7 o'Q ddress 4y r Consultant/Contractor PM <br /> Report Type&QC Level ^P64'"SUL linvoice to Consultant/Contractor or(F/-(jEb 4.Circle one) <br /> BP/GEM Account NoTele/Fax Z d P/GFM Work Release No <br /> Lab Bottle Order No Matrix Preservatives Requested Analysis <br /> Item <br /> SampleDescriptionDescription Time Laboratory No x o o Sample Point Lat/Lon <br /> g andNo <br /> n n <br /> b o O w 000 Comments <br /> d ¢ <br /> 2 Vke k rti x <br /> 3 <br /> 4 � l X <br /> 5 <br /> 6 <br /> FT7 <br /> 8 <br /> 9 <br /> 10 <br /> Sampler's Name �• ►� ed y/ ffth1!o Date Time cceptedBy/All~iLa a Date mu <br /> Sampler's Company ,v <br /> Shipment Date *7.5 107 <br /> Shipment Method w 4 <br /> Shipment Tracking No <br /> Special Instructions <br /> Custody Seals In PIace Yes No Temperature Blank Yes No X Cooler Temperature on Receipt °FIC Trip Blank Yes NoLEJ <br /> LA90RA70RY DP COC Rev 1 215102 <br />