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8% <br /> AAINFCY RC <br /> CANONIE ENVIRONMENTAL PROJECT <br /> I (See Reverse for Instructions) NO <br /> . Ji <br /> PROJECT NAME jj�fyIe- Or i_:�r 4g> kKE S SAMPLERS CS r SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> PROJECT Nl1M$ER 1 (PRINT) DESCRIPTION CODES A Ground Water F Oil <br /> T� "�[`� �,Z'L f , A 40-ml VOA Val B surface water G Waste 1 Standard <br /> (SIGN) 8 Glass Liter E brass Tube) C Leachate H Blank/Spike 2 48 Hour <br /> RECORDER C Plastic 500-mi F Oth'eF D Rrnseate I Other 3 24 Hour <br /> (SIGN) D Plastic Liter �_ oillSedimeht 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY It <br /> CONTAINERS <br /> AND U <br /> ag—g 5g PRESERVATION <br /> `ss o t lya SAMPLE <br /> $� $� i � 1` t �>; i° NOTES ASSIGNED CONDITION <br /> tTIME SAMPLE iD v , L BOTTLE UPON <br /> NUMBERS RECEIPT NOTES <br /> ------------- <br /> ----------------- <br /> r <br /> 6rd <br /> O.S <br /> 0 - <br /> � 4 <br /> in5 <br /> f <br /> ! yr <br /> 4FF <br /> NOTES!MISCELLANEOUS Relinquished by (Signature) Rtcenr (S n ure),' Date Time <br /> ��P� G s ?'(tel ' lid �QISn'►+�. r r� rr2s, t#i ,� a , i,'� � �� r, + 3q <br /> �� by 4 6 1 g03 Relinquishe By (Signature -- Recelved By Slgndturo f a e Time <br /> 10II kGane �nv�rc��l�' <br /> 790( �►tef,d C. (}I c�au,}�/,��d Relinquished By (Signature) Received By (Signature) Date Time <br /> Method of Shipment Descnption of 0 r Chains-Of Custody Dispatched By (Signature) Date Time Received for lab By (Signature) Date Time <br /> Transporl Container Transported with this <br /> Chain(by Serial No) 1 0 " <br /> q <br /> 0:� 1�C�� l? Irl L' L7 .'� h ,lel <br /> Send Lab Results to (Name) 46 r (Check Office Below) Verbals Requested Yes U No ElElPORTER LErPLEASANTON ❑ IRVINE ❑ ATLANTA ❑ OTHER <br /> TEL(219)926-8651 TEL(415)463-9117 TEL (714)757-1755 TEL(404) 951-0055 TEL <br /> FAX(219)926.7169 FAX(415) 463-2981 FAX(714) 757 0960 FAX(404)951-9364 FAX <br /> ❑ DENVER ❑ KING OF PRUSSIA El HOUSTON ❑ MT VIEW ❑ OTHER i <br /> TEL(303) 790-1747 TEL(215)337-2551 TEL(713)556-1666 TEL(415)960-1640 TEL ' <br /> FAX(303) 799-0186 FAX(215)337-0560 FAX(713) 556-0666 FAX(415)960-0739 FAX <br /> CANONIE ENVIRONMENTAL SERVICES CORP O 800 CANONIE DRIVE o PORTER, IN 46304 a TELEPHONE 219) 926-8651 a FAX 219) 926.7169 <br /> SERIAL No71 <br /> 1 2 1 1 F WHITE Field Copy YELLOW Prosect Copy PINK Laboratory Copy <br />