Laserfiche WebLink
i9 C� u i <br /> CHAIN OF CUSTODY No. 100222 Page of <br /> CO T NTS SAME , CONSULTA TS ADD ESS � Y <br /> BP SITE NUMBER BP SITE 1 FACILITY ADDRESS COU NT PRO)ECT NUMBER <br /> CONSULTANT PROJECT MANGER PHONE NUMBER FAX NUMBER CO ULT NT CONTRACT NUMBER <br /> BP CONTACT BP ADDRESS PHONE 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 CORSLIltanl Contact Name) DATE TIME SHIPMENT DATE SHIPMENT METHOD <br /> AIRBILL NUMBER <br /> TAT 24 Hours [] 48 Hours F] 72 Hours Standard 7 or 14 Days ANALYSIS REQUIRED !20q0S "I) <br /> CONTAINERS PRESERVATIVE <br /> SAMPLE DESCRIPTION COLLECTION COLLECTION MATRIX _ <br /> DATE TIME SOIUWATER NO TYPE LAB ( COMMENTS <br /> (VOL) SAMPLE# <br /> mw - Le <br /> SAMPLED BY(P#ease Print Name) SAMPLED BY(Signature) ADDITIONAL COMMENTS <br /> RELINQUISHED BY/AFFIL TION PATE TIME ACCEPTED BY lAFFILlA(IDN PATE TIME <br /> 3 ` <br /> (Print N e 1 I at r ) r�fir, (Pnr)t Nainc 1 Slgnatute) <br /> 1j.91 lt:p v <br /> CLV 16722 A[2197} <br /> P(G154 DISTRIBUTION WHITE ORIGINAL(WITH DATA) YEI LOW BP PINK LAB BLUE CONSULTANT FIELD STAFF <br />