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• <br /> CHAIN OF CUSTODY No.Q 58 73 6 Page j of _ <br /> CONSU TANT S NAME ]ADDRESS CITY STATE ZIP CODE <br /> BP SITE NUMBER M B RNER ADDRESSICITY CONSULTANT PROJECT NUMBER <br /> 11 <br /> ti Ll <br /> CONSULTA PROJECT MANAGER PHHE NUMBER XNUMBER CONSULTANT CONTRACT NUMBER <br /> 'o � '10 cSS bSo 5(0) a.5 - &oSiii, qoL-! <br /> BP CONTACT BP ADDRESS I , f PHONE NUMBER FAX NO <br /> LAB CONTACT LABORATORY ADDRESS PHONE NUMBER FAX NO <br /> SAMPLED`BYYPPlease Print Name) SAMPLED BY S SHIPMENT DATE SHIPMENT METHOD <br /> (,j CA— Ic�.�� [Jct v <br /> TAT 24 Hours 48 Hours 1 Week .Standard 2 Weeks ANALYSIS REQUIRED AIRBILL NUMBER <br /> COLLECTION CONTAINERS PRESERVATIVE 14c-- <br /> DATE MATRIX <br /> SAMPLE DESCRIPTION SOILIWATER TYPE LAB A COMMENTS <br /> coLTIME ION NO (VOL) SAMPLE# %1 <br /> L <br /> �y <br /> (� I ``I 3 s� ca G <br /> 5-7 11150 n <br /> -9 1510LU 1c) <br /> o� <br /> "ADDITIONAL COMMENTS <br /> RELINQUISHED BY/AFFILIATION DATE TIME ACCEPTED BY/AFFILIATION DATE TIME <br /> r00 <br /> r0 <br /> CLV 16722 Distribullon White-Original(with Data) Pink Lab <br /> Yellow-BP Blue Consultant Field Staff <br />