Laserfiche WebLink
CHAIN OF CUSTODY NO. 00 -287 Page of <br /> CONS ULTA 'SCIS n ADDRESSL�k N I aZCe TATE 9 ZIP CODE <br /> d V-5-9 <br /> BP SITE UMBE�_ BP CORNE ADD�hl�ro CONSULTANT_PROJECT UMBER DO� <br /> CONSULTANT PR CT ANAG V Vr PHONE <br /> 11N �l� q �� '����� FAX NUMBER ��F � � �� ��n CONT�C <br /> T NUMBER <br /> V /!5 r, <br /> BP CONTACT BP ADDRESS PHONE NUMBER FAX NO. <br /> LAB CONTACT �- LABORATORY ADDRESS PH E NUMBED FAX NO. <br /> +^�- est L �?� -(1 op 3 73 <br /> SAMPLED BY(Please Print ame) SAMPLED BY( gnature SHIPMENT DATE SHIPMEGurke4—THOD <br /> d'J' a u�} t <br /> AIRBILLNUMBER <br /> TAT: 24 66S 48 Hours 1 Wee Standard 2 Weeks ANALYSIS REQUIRED <br /> COLLECTION CONTAINERS PRESERVATIVE 0 O <br /> SAMPLE DESCRIPTION DATE MATRIX ` COMMENTS <br /> 50iLIWATER TYPE LAB <br /> COLLECTION NO. (VOL.) SAMPLE# <br /> 0 �L- 4:�� <br /> TIME <br /> 1n1 <br /> ADDITIONAL COMMENTS <br /> RELINQUISHED BY/AFFILIA N DATE TIME ACCEPTED BY/AFFILIATION DATE TIME <br /> r q lco <br /> CLV-16722 Distribution: White-Original (with Data) Pink-Lab <br /> Yellow-BP Blue-Consultant Field Staff <br />