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[7-1.7 71 --------- '7�7;77. <br /> --R-tCO-----R--D �B PROJECT <br /> /f7 ssoce, N-0 -MST' Y <br /> I F <br /> (See Reverse for Instructions) N6- 7 <br /> PROJECT NAME0JV7 co—1Z SAMPLERS 14 trX rF-COZES SAMPLE CONTAINER SAMPLE 'DESCRIPTION CODES TAT CODES <br /> 1 JPRINT) DESCRIPTION CODES A, Ground Water F. Oil <br /> PROJECT NUMBER &CV, "D-ml VOA Vial B. Surface Water G. Waste 1. Standard <br /> (SIGN) B. Glass Liter E. Brass Tube C. Leachate H. Blank/Spike 2. 48 Hour <br /> RECORDER C. Plastic 5DO-rnT F.Other D. Rinseate 1. Cther 3. 24 Hour <br /> (SIGN) 0. Plastic Liter E. SoNSediTrent 4. Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> c AND <br /> 'i 232 <br /> PRESERVATION 'P <br /> 'E, . SAMPLE <br /> 0 E'd 1 <br /> :20 ,CIO NOTES ASSIGNED CONDITION <br /> S! <br /> E— Z <br /> SAMPLE [D <br /> BOTTLE UPON <br /> DATE TIME -N z NUMBERS RECEIPT NOTES <br /> # M <br /> 1231 1115 MUJ- 1 10C.12S <br /> i 7-sm-7 I I—AD M VJ- AA 1 13 VVI <br /> -34 A A 1 11 10 IIA I <br /> NOTES I MISCELLANEOUS pJcrEi&J*o <br /> N0fI Relinqujs�by: (Signature) RecKv By: t re) Dat Time <br /> Liq 13 - 4 fat, lqs <br /> Inq h d R 'y By (SiTime <br /> 5PPb -Co-c 13TtY VleaSie Rel �<:::eZcq -. (S il u r Ela;e <br /> P0 <br /> 0;—JRelinquished By: (Signature) Received By: (SignMure) Date Time <br /> QT q7 004/8 <br /> Method of Shipment Description of Other Chains-Of-Custody Dispatched By: (Signature) Date Time Received for lab By: (Signature) bate Time <br /> Transport Container, Transported with this 7 <br /> AGA-) Chain (by Serial No.) <br /> r 14 FI — COOLZ 0 N735 <br /> Send Lab Results to (Name): -J 15- AI� (Check-Of—fice E10w) Vez'r/bals Requested: yes ED No El <br /> 11 ATLANTA El DENVER El IRVINE ❑ MT. VIEW El PORTER 9OTHER <br /> TEL (404) 951-0055 TEL(303) 790-1747 TEL(714) 757-1755 TEL(415) 960-1640 TEL(219) 926-6651 TEL�- <br /> -9364 -0186 -0960 <br /> FAX (404) 956 FAX (303) 799 FAX (714) 757 FAX (415) 9604739 FAX (219) 926-7169 <br /> El BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA El PLEASANTON El PORTLAND El 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) 337-0550 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 a FAX (303) 290-8013 <br /> SERIAL NO, - 14736 WHITE:Field Copy YELLOW:Project Copy PINK:Laboratory Copy REV,8192 <br />