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Pagc--L or <br /> Chain of Custody ecolyd On-site Tim Temp: C-)Project Name Off-site Time: Temp: <br /> B11 BU/GEM CO Portfolio: fordSky Conditions: <br /> UP Laboratory Contract Number; Meteorological Events:. <br /> Date:��� p Requested Due Date(mm/dd/yy) -- 19ind Speed: g2= Direction: <br /> Scztd I'o: P/GEM Facility No.: yew L a Consultant/Contractor: <br /> Lab Name: 13P/GEM Facility Address: Address: <br /> Lab Address: (, W ( Site IDIs <br /> *� Site LaUI,,ong: e-mail EDD; <br /> u vVf California Global ID#: T—,pd o 77 bmultant/Contractar Project No.: <br /> Lab PM: aBP/GEM PM Contact: Consultant/Contractor Tele/la <br /> Teleiaced ddress: ConsultanUContractor PM. <br /> Report'I'ypc&QC Level: � .invoice to: ConsultanUContractor o IG ircle one) <br /> 13P/GEM Account No.; Tele/pax: P/GEM Work Release No: <br /> Lab bottle Order No: Matrix Preservatives Requested Analysis <br /> IteniSample Deeeription Time Laboratory Na, A o a o Sample Point Lat/1<.ong and <br /> NO. c H °,° po Comments <br /> o00 <br /> 1 �( <br /> .�Po9v ,2 <br /> �4 Gam- p b <br /> ]COO ILK LXNI <br /> 5 I k .te TIN h <br /> 7 <br /> COO AR rEMI iERATUREZ5A <br /> 8 <br /> 10 <br /> Sampler's Name RcHuquished By!Atlllistion Date time Accepted By!AIT n Date inle <br /> Sampler's Company: 3 CD <br /> j ?� 3 <br /> Shipment Date: <br /> Shipment Method: <br /> Shipment Tracking No: <br /> .3pecial Instructions: <br /> Custody Seals In Place Yes Aw No Temperature Blank.Yes o cW Cooler Temperature on Receipt °F/C Trip Blank Yes No <br />