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i <br /> CHAIN OF CUSTODY No. 00380 Page of <br /> CONSULT TiS,AM � ESS O �� CITY STATE Zip CODE <br /> (qj ejj aoo �S`� <br /> BP SITE NU BE q 8P CORNER ADDRES CITY n CONSULTANT PROJECT NUMB R <br /> I L' 1 IT (2, b l S 1 b 6 b <br /> CONSULT T`O ECT M GE PHONE N BER r FAX N \ 1 �� T CONTRACT NR <br /> F9 <br /> BP CONTACT 4 BP ADDRESS �,A� PHONE NUMBER FAX NO. <br /> LAB CONTACT r �`A LABORATORY D.R�E�S'SL � PHONE NUM � � � � ��� FAX Na <br /> SAMPLEp BY(PleasePint Name) SAMPLED Y(Signalure) SHIPMENT DATE SHIPM T METHOD <br /> rl'd <br /> AIRBILL NUMBER <br /> TAT: 24 Hours 48 Hours 1 W k Standard 2 Weeks ANALYSIS REQUIRED <br /> COLLECTION CONTAINERS PRESERVATIVE ' <br /> SAMPLE DESCRIPTION DATE MATRIX <br /> SOIL/WATER TYPE LAB C4- ¢ COMMENTS <br /> COLTEMEVON NO. (VOL.) SAMPLE# <br /> W r 3�o <br /> v`1 - <br /> (� •- a� w 3ac�3 <br /> l <br /> ADDITIONAL COMMENTS <br /> RELINQUIS D BY/AFFILIATION DATE TIME ACCEPTED BY/AFFILIATION DATE TIME <br /> III 1_4 KX13 <br /> CLV-16722 Distribution, White•Original (with Data) Pink-Lab <br /> Yellow-BP Blue-Consultant Field StaffC>k1 I „ `� <br />