Laserfiche WebLink
-o11 466 <br /> CHAIN OF CUSTODY NO.O 8 2 6 6 0 Page�of� <br /> CITY TATE ZIP CODE <br /> CONSULT NT'S NA E ADDRESS .IZbj <br /> f {.� <br /> CONSULTANT pROlECT NUMBER <br /> BP SITE UMBER 1` 4 BP CORN ADDRESS/CITY 10— u 3-7 -J- <br /> I 1 l 'L FAX NUMBER CONS JLTANT CONTRACT NUMBER <br /> CONSULTAN ROJECT MANAGER PHONE NUMBER <br /> I� X10 S b -1 2 -3 O-s <br /> PHONE NUMBER FAX NO �- <br /> BP CONTACT BP ADDRESS <br /> Lti 1 r1 i� LQ FAX NO. <br /> LABORATORY ADDRESS PH NUMBER <br /> LAB CONTACT � � � �� f � �(� 'U -� Q�d I <br /> S SHIPMENT ET OD <br /> SAMPLED B Signature] t SHIPMENT DATE _ - <br /> SAMPLED BY IPteas Print Name) <br /> Lk AIRBILL NUMBER <br /> ))) ANALYSIS REQUIRED p 53 <br /> TAT: ❑ 24 Hours ❑ 48 Hours ❑ 1 We Standard 2 Weeks <br /> COLLECTION CONTAINERS PRESERVATIVE I 1� <br /> DATE MATRIX COMMENDS <br /> SAMPLE DESCRIPTION S01UWATER TYPE LAB <br /> COLLECTION NO- (VOL.) SAMPLE# r� <br /> TIME �\ <br /> `C <br /> lrr <br /> ADDITIONAL COMMENTS <br /> ELINOUISH D BY 1 AFFILI N DATE TIME ACCEPTED BY 1 AFFILIATION DATE TIME <br /> � t <br /> �v <br /> Distribution: White•Original(with Data) Pink-Lab <br /> CIV 1s7z2 81ue Consultant Field Staff <br /> PI<r15n Yellow-BP <br />