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CHAIN OF CUSTODY No. 098772 Page-1 of <br /> CONkULTA(T7MECONSULTANTS ADDRESS C, <br /> r <br /> BP SITE NUMB��\ BP ITE I FACILITY ADDR�A r CONS ULTANT'PROJECT NUMBER <br /> CONSULTANTCO=ER N PHONE NUMBER j FAX NUMBER CONSULTANT CONTRACT NUMBER <br /> --05�)O) )-'a T-- )4, ---o -s- —�I cQ �A <br /> BP CONTACT BP ADDRESS o 4- PHONE NUMBER FAX NO. <br /> LAB CONTACTLABORATORY ADDRESS PHONE NUMBER FAX NO. <br /> � PL 5 <br /> =i7—,e Ae <br /> BP CONTACT REQUESTING RUSH TAT(Print BP Contact Name) RUSH REQUE9TED OF(Print Consultant Contact Name) DATE/TIME SHIPMENT DATE SHIPMENT METIHOD <br /> F-Fid Ex <br /> AIRBILL NUMBER <br /> TAT: D 24 Hours F-] 48 Hours 72 Hours X's) fl,tandard 7 or 14 Days ANALYSIS 3,%, L� q 4-1 a- 15 1 <br /> Yull LU 0 <br /> CONTAINERS PRESERVATIVE i ;7� -9 Uj 0 biREQUIRED <br /> SAMPLE DESCRIPTION COLLECTION COLLECTION MATRIX <br /> DATE TIME SOJUWATER NO. TYPE LAB -a-p-H COMMENTS <br /> (VOL.) SAMPLE# <br /> 4x <br /> x x <br /> NIV <br /> SAMPLED BY(Please Print Name) SAMPLED BY(Signature) ADDITIONAL COMMENTS <br /> —7e�p 3'c— <br /> RtINQUISHED BY/AFFILIATION DATE TIME ACCEPTED BY/AFFILIATION DATE TIME <br /> (Print NaMl Signature) 0 (Print Name/Signature) <br /> 07 <br /> CLV-16722-A(2/97) <br /> PKG/50 <br /> DISTRIBUTION: WHITE-ORIGINAL(WITH DATA) YELLOW-BP PINK-LAB BLUE-CONSULTANT FIELD STAFF <br />