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CHAIN OF CUSTODY NO-0 7 5 8 2 3Page of <br /> CONSULTANT'S NAME ADDRESS I I — <br /> CITY STATE ZIP CODE <br /> BP SITE NUMBERBP CORNER ADDRESSICITY —� <br /> CONSULTANT PROJECT-NUMBER" <br /> cal S- <br /> CONSULTANT PROJECT MANAGER PHONE NUMBER FAX NUMBER CONSULTANT CONTRACT NUMBER <br /> �k - �� k, Z�,)—?--, !�- <br /> P-1 - 40 k � k ( — ( '5 --z ---�- I c, % - <br /> BP CONTACT BP ADDRESS PHONE NUMBER FAX NO <br /> LAB CONTACT LABORATORY ADDRESS PHONE NUMBER FAX NO. <br /> SAMPLED BY(Please Print Name) <br /> PLED BY(Signature) SHIPMENT�] SHIPMENT METHOD <br /> 61— <br /> AIRBILL NUMBER <br /> TAT: ❑ 24 Hours 48 Hours I Week Standard 2 Weeks ANALYSIS REQUIRED <br /> (r <br /> COLLECETION CONTAINERS PRESERVATIVE <br /> DAT <br /> SAMPLE DESCRIPTION MATRIX—SIDIUWATER TYPE LAB COMMENTS <br /> COLLECTION <br /> TJMI-= NO. (VOL.) SAMPLE# <br /> RELINQUISHED BY/AFFILIATION DATE TIME ACCEPTED BY/AFFILIATION DATE TIME ADDITIONAL COMMENTS <br /> &J <br /> �T <br /> CLV-122 <br /> 'p`Kr,tso67Distribution: White-Original (with Data) Pink-Lab <br /> Yellow-Bp Blue-Consultant Field Staff <br />