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CHAIN OF CUSTODY No- 095813 Page—Lot <br /> CONSULT r5 t4A E CONSULTANT'S ADDRESS <br /> 7160,1 Aild c' <br /> BP SITE N MBER J1 BP SIT/FACILITY ADDR 5 CONSULTANT PROJECT NUi <br /> CONSULT PROJE T MANG P NE NUMBER FAX NUMBER CONSULTANT CONTRACT NU BER <br /> I-N A-P—Xx I L-e to <br /> q a <br /> BP CONTAC D BP PRESS PHON NUMBER FAX NO. <br /> LAB CONTACT LABORATORY ADDRESS PHONE NUMBER FAX NO. <br /> BP CONTACT REQUESTING RUSH TAT(Print BP Contact Name) RUSH REQUESTED OF(Print Consultant Contact Name) DATErTIME SHIPMENT DATE SHIPMENT METHOD <br /> AIRBILL NUMBER <br /> TAT: � 24 Hours � 48 Hours � 72 Hours Standard 7 or 14 Days "� ANALYSIS REQUIREDi V, �j(7 q��ly <br /> CONTAINERS PRESERVATIVE P p f S p <br /> SAMPLE DESCRIPTION COLLECTION COLLECTION MATRIX <br /> DATE TIME SOItJWATER TYPE LAB �]- ( CaQ COMMENTS <br /> N0. (VOL.) SAMPLE# <br /> Y <br /> Is <br /> — <br /> c _ <br /> SAMPLED BY(P4ease Print Name) SAMPLED BY(Signature) ADDITIONAL COMMENTS <br /> Ask <br /> ELINQUISHED BY/AFFILIATION E ACCEPTED BY/AFFILIATION DATE TIME d <br /> (Priv ame 1 Signature) - (Print Name 1 Signature) <br /> DATE TIME l�s �]d I`8To <br /> CLV-16722-A(2197) <br /> PKG15D DISTRIBUTION; WHITE-ORIGINAL(WITH DATA) YELLOW-BP PINK-{AB BLUE-CONSULTANT FIELD STAFF <br />