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JA <br /> CHAIN OFC TODY Page of <br /> EONSULTANT'S NAME CONSULTANTS ADDRESS <br /> Blaine Tech Services, Inc 1680 Ro ers Ave , San Jose CA 95112 <br /> P SITE NUMBER GLOBAL ID BP SITE!FACILITY ADDRESS CONSULTANT PROJECT NUMBER <br /> 11194 T0607700011 2375 Tracy Blvd , Trac <br /> ONSULTANT PROJECT MANAGER PHONE NUMBER FAX NUMBER CONSULTANT CONTRACT NUMBER <br /> Andy Magyar (408) 573-0555 x 221 (408)573-7771 <br /> P CONTACT BP ADDRESS PHONE NUMBER FAX NO <br /> Scott Hooton 295 SW 41st Street, Suite N, Renton WA 425 251-0689 (425)251-0736 <br /> 4B CONTACT C O tlttfac LABORATORY ADDRESS PHONE NUMBER FAX NO <br /> 'ace- Paula Kirtle vp—b-arla 900 Gement Ave , Houston, TX 77058 281 488-1810 281 488-4661 <br /> P CONTACT REQUESTING RUSH TAT(Pnnt BP Contact Name) RUSH REQUESTED OF(Print Consultant Contact Name) DAT 1TIME SHIIPMENT DATE SHIPMENT METHOD <br /> AIRBILL NUMBER <br /> 4T El24 HOURS ❑ 48 HOURS ❑ 72 HOURS Standard 7 or 14 Days ANALYSIS REQUIRED <br /> CONTAINERS I PRESERVATIVE <br /> UJI <br /> W o <br /> COLLECTION COLLECTION MATRIX N COMMENTS <br /> SAMPLE DESCRIPTION DATE TIME SOiL/WATER NO TYPE LAS ,'� m w w <br /> (VOL) SAMPLE# m E; X <br /> + + <br /> p + <br /> S uj N <br /> Had <br /> w` �D <br /> SAMPLED BY Sin u ADDITIONAL COMMENTS <br /> 4MPLED BY(Please Print Name) f ! { g t ) r <br /> RELINQUISHED BY/AFFILIATION ACCEPTED BY/AFFILIATION (Print DATE TIME <br /> (Print Name I Signature) GATE TIME Name/Signature) <br /> 1 <br />