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CONSULTANT ADDRESS <br /> CHAIN OF CUSTODY No.O G 98 2 Page of <br /> 5 NA1>rE <br /> CITY STATE ZIP CODE <br /> 3 03 Fno potr-K Dr e �1 D RAv�ci� Co r-c�oV 0. dA 1 <br /> BP SITE NUMBER BP CORNER ADDRESS CITY C'S GJ 6,7-D <br /> 146 9 1�a+h r�'I Gr' LAS e CONS LTANT Pq JECT NUMBER <br /> S�ock1 y3oo. -o/ <br /> CONSULTANT PROJECT MANAGER PHONE NUMBER <br /> Gar aa,^t{er ?1( - 6 31 r 30� FAX NUMBER CONSULTANT CONTRACT NUMBER <br /> 5P CONTACT BP ADDRESS 2 9�6- 6 31 -/:317 G I Z 1 p <br /> 5C0 � L.lao` �A-,/ ,SW �- {, PHONE NUMBER <br /> ! ( r 3 TE lv K'�-�r1 IJA- 2-06--ZS -D68 FAX NO <br /> LAB coNTacT �e �0. O �S'oS � 9 2-o6 -- Z51 — 0-1-36 <br /> LABO TOR ADDRESS 3 PHONE NUMBER -� o{ FAX NO <br /> /J •� <br /> SAt+pLED 8Y{Please Pn4 FL <br /> G�n Name) SAMPLE Y{S"gnalure} [ 01 —zi Tg ~2-67-1 <br /> SHIPMENT DATE <br /> V16, C0—(,^ -tr SHIPMENT METHOD <br /> Fi-b 3 1T?S Fed• fix. <br /> TAT ❑ 24 Hours ❑ as Hours 1 Week andard 2 Weeks ANALYSIS REQUIRED AIRBILL NUMBER <br /> 306oY4133eS <br /> COLLECTION CONTAINERS PRESERVATIVE <br /> SAMPLE DESCRIPTION DATE MATRIX V <br /> SOIUWATER TYPE LAB <br /> COLLECTION NO $ COMMENTS <br /> TIME (VOL) SAMPLE# �D <br /> 86 q6 •S <br /> ---- <br /> 86 - 51 <br /> -- y6 <br /> i-z os <br /> 5 z-z- X X <br /> 13:00 Sart 1 X X <br /> 2-zoo so,� <br /> X d� 5P- <br /> RELINQUISHED BY/AFFtLIATION DATE TIMEADDITIONAL COMMENTS <br /> EPTED BY/AFFILIATION DATE TIME <br /> CLV,6>r2 <br /> Distribution White-Original(with Data) Pink Lab <br /> � Yellow BP <br /> Blue Consultant Field Stats <br />