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`m- <br /> Chain of Custody Record L D V On-site jitmV;Sgls Temp: v <br /> ;. <br /> Project Name av0k �� -- Off- Time: t} Temp: �] <br /> BP]I3U1GlJiWI CO Portfolio: 44A.%rt.,y,- rha Sky conditions: alc4 e_ <br /> BP Lal?oi atal'y Contract Nuzni?ex: Meteorological Events: •t ` <br /> Date: Requested Due Date(mm/dd/yy)S!Lw D '�` � Wind Speed: Direction: <br /> Send To: BPIGRM Facility No.: 57SI Consultant/Contractor: -A6 <br /> Lab Narac: ,s1,�- PMEM Facility Address: L'7 (moi' rl li•+11,, C dress: e7 C t• <br /> Lab Address: f W =]i$„ Site Ill No.1!11412 �.er►a,J e4tiR.(L /.�- <br /> ,{rt ./ j e4& 01s,03�' . Site LattUng: e-mail EDD: <br /> alifotnia Global ID#:�' Consultant/Contractor Project No.: V YIC <br /> I ab PM: ,rb. E3P/G>JM PM Contact: Consultant/Contractor Tele/ ax p <br /> Tele/Fax:[ dF1774p �j„ Q' Address: onsultant/Conuactor PM:,7'& �J <br /> Report Type&QC Level: Invoice to: ConsultanttContractor or BP/GEM (Circle oue) <br /> IIP/GEM Account No.: Tele/Fax.- P/GRM Work Release No: <br /> Lab Bottle Order No: Matrix Preservatives Req lysis <br /> l�'Iitl619Or ' <br /> v <br /> XtemSample Point Lau-Long and <br /> Na. Santply Description Time o Laboratory Na. N 00N N a Comments <br /> a � O <br /> m <br /> ✓i Gia <br /> OWL- <br /> V4 <br /> d t$ 1r of <br /> o n� <br /> 8 lr. x ori 6 <br /> k Flo r� to <br /> f Sampler's Name: r([� Relin wished By/Af llistion Date !me ecaptea 13y l Ailills n ate ime <br /> Samplees Company: �. V <br /> Z-- G <br /> Shipment Date lU <br /> Shipment Method: *-(}, <br /> Shipment Tracking No: <br /> pecial Instructions: <br /> ody Seals In Place Yes AC No Temperature Blank Yes No o!k Cooler Temperature ori Receipt ° Trip 131ank Yes' No <br /> LABORATORY - BY COC Rev.1 2!5101 <br /> - I <br /> I <br />