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cI <br /> r � <br /> CHAIN OF CUSTODY No.0 6 2 8 3 4 Page of <br /> III CITYJ STATE � ZIP CODE <br /> CONSU ANT'S NAME ADDRESS <br /> l ` '�t & A <br /> �[ a � � <br /> CONSULTANT PROJECT NUMBER <br /> 8P SITE NUMBER BPC RNER ADDRESS/CITY <br /> � � [� ~" !S b <br /> � 3 <br /> � oa <br /> FAX NUMBER CONSULTANT CONTRACT NUMBER <br /> CONSULTAN P`OJE GT MAA ER <br /> �� <br /> NP—CONTACT <br /> BP ADDRESS <br /> PHONE NUMBER FAX N0. <br /> Sb PHONE NUMBER FAX NO. <br /> LAB CONTACT LABORATORY ADDRESS Y T p 2 -*� y <br /> ovk� a $ uv DJ d- <br /> SHIPMENT DATE SHIPMENT METHOD <br /> SAMP ED BY(Please r 1 Name} SAMPLED BY(Sig lure) � ; <br /> Y�rr M+1 vj <br /> AIRBILL NUMBER <br /> TAT: 24 Hours 48 Hours 1 Week S andard 2 Weeks ANALYSIS REQUIRED <br /> COLLECTION CoNTAINERS PRESERVATIVE T_ <br /> DATE MATRIXCOMMENTS <br /> SAMPLE DESCRIPTION SOIUWATER TYPE LAB Q D� <br /> COLLECTION NO. (VOL.) SAMPLE# I� <br /> TIME C <br /> am L <br /> -S "3 <br /> _ 55LI 1.0 <br /> ADDITIONAL COMMENTS <br /> RELINQUISHED BY/AFFILIATION DATE TIME ACC TED BY 1 FFILIATION DATE TIME <br /> v � ✓ 1' 30 <br /> v-16722 Distribution: White Original (with Data) Pink Lab <br /> Yellow-BP Blue-Consultant Field Staff <br />