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Amh Page �'of <br /> Chain of Custodoecord 4- U <br /> Cm-site Time Temp <br /> Project Name e) Zt d Off-site Time Temp <br /> BP B U/GEM CO Portfolio: 'ci l s Conditions <br /> ' <br /> BP Laboratory Conti act Nu.niber: 01 <br /> Date: �f(v Meteorological Events, -Cr <br /> Requested Due Date(mm/dd/yy} TA WInd Speed -gLDirection <br /> S <br /> end onsultant/ConP/GEM Facility Address '7 Ap ddress 70 pfit; A�( W Site 1D No <br /> ite Lat/Long, e-mail EDD <br /> aIifotnia Global ID# O `onsultant/Contractor Project No <br /> BPIGEM ntactCo11su1tant/Contraetor TelelFax 'P"lL r Zoo <br /> r Address <br /> Report Type&QC Level 1 Consultant/Contractor PM <br /> 11P/GEM Account No voice to Consultant/Contractor or (Circle one) <br /> Lab Bottle Order No <br /> ele/Fax 10 PL/.GEM Work Release No <br /> Matrix Preservatives <br /> Requested Analy r <br /> Item <br /> No Sample Description Time bLaNo x <br /> o Laboratory No, o Sample Point Lat/Long and <br /> w c Comments <br /> 2 -r3 <br /> 1 <br /> AQM <br /> 4 1 ID <br /> 08 D <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> 10 <br /> Sampler's Name RehnquUhed By 1 Altilisdon xte hne ccepted By AM1610011 to hne <br /> Sarn ier's Company, CgvAtkjr <br /> 3ht ment Date la <br /> iht meet Method <br /> >hipment Traelung No, <br /> rpccialInstructions. <br /> At <br /> Astody Seals In Place Yes ..r No Temperatur �IankYes o �-- ^` Cooler Temperature on Receipt °FIC Tnp Blank Yes Na -�" <br />