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ocrb�o <br /> CHAIN OF CUSTODY No. 4 8 5 817 Page 1 Of�,_ <br /> CONSULTA T'�NA E CON LJTANT'S ADDRESS <br /> • � <br /> BP SITE NUMBER 111BP SITI/FACILITY ADDR SS 1 CONSULTANT PROJECT NUMBER 3 �, gyp - <br /> CONSULTANT PR JECT MA 1GER PHONE NUMBER FAX NUMBER CONSU T NT CONTRACT NUMBER <br /> a-Pr --t a-3 <br /> BP CONTACT BP DDRES PHONE NUMBER FAX NO. <br /> LAB CONTACT LABORATORY ADDRESS I PHONE NUMBER FAX NO, <br /> BP CONTACT REQUESTING RUSH TAT(Print BP Contact Name) RUSH REQUESTED OF(Print Consultant Contact Name) DATEITIME SHIPMENT DATE SHIPMENT THOD <br /> TAT: 24 Hours ❑ 48 Hours ❑ 72 Hours Standard 7 or 14 Days ANALYSIS REQUIRED AIRBILL NUMBER <br /> CONTAINERS PRESERVATIVE <br /> SAMPLE DESCRIPTION COLLECTION COLLECTION MATRIX COMMENTS <br /> DATE TIME SOIL/WATER NO TYPE LAB <br /> (VOL) SAMPLE# <br /> S - 1 <br /> 5 �- <br /> SAMPLED BY{Please Print Name) SAMPLED BY(Signature) ADDITIONAL,,QOMMENTS <br /> ELINQUISHED BY/AFFILIATION ACCEPTED BY/AFFILIATION <br /> (Print N e/Signature) DATE TIME (Print Name/Signature) DATE TIME <br /> — 2 — <br /> Li L4 ggP11515 <br /> CLV-16722-A(8/96) <br /> PKGl50 DISTRIBUTION. WHITE-ORIGINAL(WITH DATA) YELLOW-BP PINK-LAR BLUE-CONSULTANT FIELD STAFF <br />