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Date: F - Z - 0 L. <br />Chain of Custody Record <br />Project Name Mco ; t o <br />BP BU/GENT (A) Portfolio: �fA4 L -Lh r rl <br />1111 Laboratory Conti -act Number: <br />Requested Due Date (mm/dd/yy) Y - /G O 2 <br />moi('tf-7-0z V <br />-site Time: Temp: <br />ff- site Time: Temp: <br />W20E3a <br />Meteorological Events: <br />Wind Speed: Direction: <br />send "re: <br />JL_ <br />l3F/GEM Facility No.: 2 <br />onsultant/Contractor: <br />tab Name: J <br />Bl'/GEM Facility Address:z <br />Q % <br />ddress: Q® <br />I ab Address: <br />Site ID No. Z:3 <br />lonsultant/Contractor <br />Site Lat/Long: ' - <br />, 3 <br />mail EDD: <br />alifornia Global ID t1: O ADD Z <br />Project No.: 1rp <br />Lab PM: <br />'T'cle/Fax: <br />IIP/GEM PM Contact: t J <br />1Consultant/Contractor <br />Tele/Fax: / - Q <br />292 <br />Address:Consultant/Contractor <br />PM: <br />type (1t Level: <br />Invoice to: Consultant/Contractor or BP/GEM (Circle one) <br />F <br />TsM Account No.; <br />o <br />Ttab <br />I'cic/l ax: L '_ 2 �' <br />BP/GEM Work Release No:ottle <br />Order No: <br />Matrix <br />Preservatives <br />Requested <br />alysls <br />Item <br />b <br />� <br />ro <br />vw �' <br />n° <br />No. <br />Sample Description <br />Time <br />d <br />Q <br />�' <br />pi <br />Laboratory No. v <br />px <br />o <br />4 10 ., Sample Point Lat/Lang and <br />tFa <br />o <br />to <br /><, <br />ti <br />t' " <br />J Comments <br />rA <br />V; <br />01A <br />Kx <br />2 <br />$ - <br />• zo <br />0 -2 -AB <br />J <br />3 <br />RI&Avt► <br />4 <br />14col, <br />5 <br />�r <br />7 <br />8 <br />02 <br />9 <br />S <br />10 <br />S <br />Sampler's Name: <br />1#,,eRelinquished <br />H1,JAMHMtio <br />Date <br />rtnn <br />Accepted <br />R /Affiliation <br />- <br />Date <br />Sam lees Company: O .s p <br />Shipment Date: �. uL <br />vac <br />O <br />Shipment Method: yr <br />I /, <br />_ <br />Shipment Tracking No: <br />Special Instructions: <br />C etetntiv Zpale In Pla.•n V ­ <br />Ar. .n <br />*'_---_---•__--- <br />,,._ ., .. <br />n a <br />.Ml," nto l U Uial,n I Us 1\111 1,00lcr 1 cmperature on KCCclpt ­L/t: Trip Blank Yes No <br />I AF40FIATo FIY TIPCOC R— 119M? <br />