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e J' Of <br /> i <br /> . ChOn ©f C1)Ilstody eord �. :r- %�� On-site Time: Temp: <br /> Rroject Name Off-site Time: Temp.- <br /> u 3puJ/DIEM C® Port%7*a: - Sky Conditions: <br /> k 3P Laboratory Contract plumber: �- eteorological Events: <br /> bete: Requested Due Date(mm/dd/yy) i` <.L,% )41 Wind Speed: Direction: <br /> end To: hP/GEM Facility No.: onsultant/Contractor: �`'y�j`r� <br /> Lab Name: ' P/GEM Facility Address* ;~/ /, �,^, ►f._' 7 f%....r�. ddress: `Yif <br /> ;Lab Address: Site ID Na. I ' `,� ir;,,.sr�-tet ' <br /> { Site LaVLon <br /> g: -mail EDD: <br /> California Global ID#: Consultant/Contractor Project No.: �L('/pV <br /> Lab PiVf: P/GEM PM Contact: ` J ! Consultant/Contractor Tele/Fax: l�:i!7'/._n `! <br /> {Tele/Fax: Address: Consultant/ContractorPM: <br /> Report Type&QC Level: Invoice to: Consultant/Contractor or BP/GEM (Circle one) <br /> BPIGEM Account No.: ele/Fax: P/GEM Work Release No: <br /> Lab Bottle Order No: Matrix Preservatives Requested Analysis <br /> f <br /> Flo l� Sample Sample eceription Time :2 ar a Laboratory No. o x o U1 `% Point Lat/Long and <br /> Comments <br /> v� a z z <br /> 2 f" <br /> 3 <br /> S f f <br /> 6 <br /> g a y <br /> 10 <br /> JSampler'sNarnne: r ReWigubird By I AEtilistion Date 7. ceepted By/Affiliation DIate ime <br /> ;Shipment <br /> mpler's Company: / Y �, �, <br /> ipment Date: t <br /> Method: <br /> Shipment Tracking No: <br /> Special Tnatructions: <br /> Custody Seals In Place Yes No Temperature Blank Yes No Cooler Temperature an Receipt °FIC Trip Blank Yes No .� <br /> CONSUL AN / NFRA R BP COC Rev.1 2/5102 <br />