Laserfiche WebLink
CANONIE ENVIRONMENTAh `RAIN-OF'-CUSTODY RECORD - As �Ro.��c� <br /> �-, - . <br /> " (See Revers& or Instructions) <br /> PROJECT NAME -I?d!­CII-r ` 444' SAMPLERS t r C'AJ^ 2 `- (J- SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> I `y IQI \ DESCRIPTION CODES A. Ground Water F. oil <br /> PROJECT NUMBER `S~ [J 0� A, 40-ml VOA Vial B. Surface Water G. Waste 1. Standard <br /> t <br /> (SIGN) B. Glass Liter E. Brass Tube C. Leachate H. SlanWSpike 2. 48 Hour <br /> C. Plas �D-i <br /> tic 500.m1 F.Other 0. Rinseale 1. Other__ 3. 24 Hour y1 \ <br /> RECORDER D. Plastic Liter E. Sail/Sediment —._,�—�.--- 4. Other <br /> (SIGN) <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> aAND _ a <br /> PRESERVATION <br /> 1''44 g. s mx SAMPLE <br /> ME <br /> Q `� NOTES ASSIGNED CONDITION <br /> �= ° BOTTLE UPON <br /> DATE TIME SAMPLE ID o z NUMBERS RECEIPT NOTES <br /> ! 5_U �- <br /> H_[i_' <br /> NOTES I MISCELLANEOUS fit linq ' d by: iga elved By: ( ignalur ) Date Time <br /> nature) <br /> ��,'t^-tom; l.�•L+� , <br /> Relinquished By: (Signature) Received By: (Signature) Data Time <br /> J+Ar65 t'f E SPS <br /> Relinquished By: (Signature) Received By: (Signature) Date Time <br /> Y PT <br /> Method of Shipm nt 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 /> Chain (by Serial No.) <br /> Send Lab Results to (Name): t t U S[7p\ (Check Office Below) Verbals Requested: Yes El No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT. VIEW ❑ PORTER OTHER w�S <br /> z, <br /> TEL(404) 951-0055 TEL (303) 790-1747 TEL (714)757-1755 TEL(415) 960-1640 TEL(219) 826-8651 TELA <br /> FAX (404) 956-9364 FAX (303) 799-0186 FAX (714) 757-0960 FAX (415) 960-0739 FAX (219) 926-7169 FAX <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING <br /> PRUSSIA <br /> ❑ PLEASATEL (5 ON463-9117 TON ElTPORTLAND . <br /> R LAND41.0282❑ TEL TEL TEL (406) 586-9496 TEL(713) 556-1666 ( 15) <br /> FAX (406) 586-9724 FAX(713) 556-0666 FAX(215) 337-0560 FAX (510) 463-2981 FAX (503) 241-0466 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP. • 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 • TELEPHONE 1'303) 290-8336 • FAX (303) 290-$013 <br /> REV.6172 <br /> SERIAL NO. ; ^� WHITE:Fleid Copy YELLOW:Project Copy PINK:Laboratory Copy <br />