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e_4 o f '. -- <br /> Chain of Custody-Word ) On-site Time: Temp: <br /> 4:tb Project Name �� t-� T Off-site Time: Temp: <br /> BP BU/GEM CO Portfolio: Sky Conditions: <br /> BP Laboratory Contract Number: Ddetcorological Events: <br /> Date: LJ —2, Requested Due Date(mm/dd/yy) ,60= Wind Speed: Direction: <br /> Send To: RP/GEM Facility No.: i. Consuttant/Contractor: <br /> Lab Name: �,y,�„ BP/GEM Facility Address: Address: 6 (21�1?""kr, f?�% <br /> Lab Address: Site ID No. 91T, , <br /> / Site Lat/Long: -mail EDD: <br /> California Global ID#:]LOY. 45- } , Consultant/Contractor Project No.. +' ; r <br /> Lab PM: BP/GEM PM Contact: Consultant/Contractor Tele/Fax: h ,_. 2 ` <br /> Tele/Fax: Address: Consultant/Contractor PM: 14 <br /> Report Type&QC Level: Invoice to: Consultant/Contractor or BP/GEM (Circle one) <br /> BP/GEM Account No.: Tele/Fax: P/GEM Work Release No: - <br /> Lab Bottle Order No: Matrix Preservatives Requested Analysis <br /> w <br /> v <br /> Item y N x �` Sample Point Lat/Long and <br /> No, 00 <br /> Sample Description Time o a Laboratory No. CD '= Comments <br /> .. y 00 00 r <br /> 3 a z x x � <br /> 1 M► : <br /> t <br /> 7 <br /> 8 <br /> 9 <br /> 10 IF <br /> Sampler's Name:;' RebngWs d By,,%Affiliation nate ime [Accepted By!Affiliation Bate time <br /> Sampler's Company: <br /> Shipment Date: <br /> Shipment Method: "',-,-!,-,. <br /> Shipment Tracking No: <br /> Special Instructions: <br /> Custody Seals In Place Yes >"o Temperature Blank Yes No Cooler Temperature on Receipt °F/C Trip Blank Yes N <br /> r A HP COC Revel sroz <br />