Laserfiche WebLink
fi M M M M M M M M M M M M M <br /> CANONIE ENVIRONMENTALWHAIN-OF-CUSTODY RECORD �f'ROJBCT <br /> `jli <br /> See R ver for Instructions) NO <br /> PROJECT NAME )` 1 �--- �(/ ((�f.w 1ii(JV� <br /> SAMPLERS SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> /2 f P'�L" ��— DESCRIPTION CODES A Ground Weler F Oil <br /> PROJECT NUMBER r 'w <br /> A 4D mf VOA Vial 9 Surface Water G Waste 1 Standard <br /> (SIGN) 8 Glass Liter E Brass Tube C Leachate N Blank7Spike 2 48 Hour <br /> RECORDER C Plaslic 500,ml F Other D Rlnseate I Other 3 24 Hour <br /> (SIGN) D Plaslic Liter E SoIVSedtment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND Y <br /> PRESERVATION f� <br /> I< L� I' r SAMPLE <br /> $ a $ F a NOTES ASSIGNED CONDITION <br /> - <br /> D T BOTTLE UPON <br /> TIME SAMPLE ID NUMBERS RECEIPT NOTES <br /> � x r <br /> 7,-jr <br /> Cis-5 ` - , t ? x <br /> NOTES l MISCELLANEOUS Olin a ed pgnalure) RpqWved By Ctlgna�rc) r Date/ Ti e <br /> ll � Rolinqulshed By (Signature) Received By (Signature) Date Time <br /> t <br /> Relinquished By (Signature) Received By (Signature) Dale Time <br /> Method of Shipment Description of Other Chains-Of Custody Dispatched By (Signature) Date Time Received for lab By (Signature) Date Time <br /> Transport Container Transported with this <br /> Coo/- Chain(by Serval No) <br /> Send Lab Results to (Name) (Check Office Below) Ve►bals Requested Yes ❑ No <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER EfOTHER <br /> TEL(404) 9510055 TEL (303) 790-1747 TEL(714) 757-1755 TEL(415)9601640 TEL(219) 926 8651 TEL <br /> FAX (404)956-9364 FAX (303) 799 0186 FAX(714) 757-0960 FAX(415) 960 0739 FAX(219) 926 7169 FAX ~_1-5' <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER <br /> TEL(406)586-9496 TEL(713)556.1666 TEL(215) 337 2551 TEL(510)463 9117 TEL (503) 241-0282 TEL <br /> FAX(406) 586-9724 FAX(713)556 0666 FAX(215) 337 0560 FAX(510) 463 2981 FAX (503) 241-0486 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP • 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 • TELEPHONE (303) 290-8336 • FAX (303) 290-8013 _ <br /> SERIAL NO 18667 _ WHITE Field Copy YELLOW Pro)ect Copy PINK Laboratory Copy FIEV 8182 <br />