Laserfiche WebLink
ow <br /> CHAIN OF CUSTODY <br /> Page_j —of <br /> CONSULTANT S NAME CONSULTANT S ADDRESS <br /> Blame Tech Services, Inc 1680 Rogers Ave , San Jose CA 95112 <br /> BP SITE NUMBER 72'375 <br /> ITE!FACILITY ADDRESS CONSULTANT PROJECT NUMBER <br /> 11194 Tracy Blvd , Tracy 0/6/Z7-K77 <br /> CONSUI-TANT <br /> /6 7- <br /> CONSULTANT PROJECT MANAGER PHONE NUMBER FAX NUMBER CONSULTANT CONTRACT NUMBER <br /> Scott Boor (408) 573-0555 x 223 (408) 573-7771 J594672 <br /> BP 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 /> LAB CONTACT LABORATORY ADDRESS PHONE NUMBER FAX NO <br /> Pace-Paula Klrtley 900 Gemini Ave , Houston, TX 77058 1 (281)488-1810 (281)488-4661 <br /> BP CONTACT REQUESTING RUSH TAT(Print BP Contact Name) RUSH REQUESTED OF(Print Consultant Contact Name) DATElTIME SHIIPMENT DATE SHIPMENT METHOD <br /> TAT ❑ 24 HOURS ❑ 48 HOURS ❑ 72 HOURS ❑ Standard 7 or 14 Days ANALYSIS REQUIRED AIRBILL NUMBER <br /> CONTAINERS PRESERVATIVE <br /> w <br /> SAMPLE DESCRIPTION COLLECTION COLLECTION MATRIX g m COMMENTS <br /> DATE TIME 501LM1ATER NO TYPE LAB `x m z m <br /> (VOL) SAMPLE# m " o <br /> U.1 <br /> o <br /> + m x + <br /> az Q Uj r <br /> °v F M m <br /> A;I ZS- <br /> C 1 � \y -t-4- <br /> 4 <br /> I L <br /> SAMPLED BY(Please Print Name) ,/ ` SAMPLED BY(Signature)Aw ZIL— ADDITIONAL COMMENTS <br /> RELINQUISHED BY!AFFILIATION Y ACCEPTED BY 1 AFFILIAT N (Print <br /> DATE TIME DATE TIME /�� oc— <br /> (P t Nao! nature) Name!Signature) ( ) <br />