Laserfiche WebLink
I <br /> CION EiMRMElffALq&Alff-OP-IU4%D?%EMORd 4PA"BPROJECT <br /> 0, E -s,4 <br /> r, !; �^ r1(See Reverse for Instructions) NO <br /> PROJECT NAME Q c( SAMPLERS +'J����� ` r SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES a <br /> c� DESCRIPTION CODES A Ground water F Oil <br /> PROJECT NUMBER J A 40-ml VOA Vial _ B surlace water G waste rStaiSda7�, {� <br /> y <br /> (SIGN) B Glass Liter EyJ rasAp.ju4d C Leachato H SlanklSpike 2 48 Ro­u r <br /> RECORDER ®j t~� C Plastic 500-ml F Other D Rinseate 1 Other 3 24 Hour <br /> iSIGN) D Plastic Luer E en 4 Olher t <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY 4- <br /> CONTAINERS <br /> AND Y <br /> PRESERVATION �8' $ w <br /> s i d LL t 11l SAMPLE <br /> av`o° NOTES ASSIGNED CONDITION <br /> BOTTLE UPON <br /> DATE TIME SAMPLE tD � I ~ NUMBERS RECEIPT NOTES <br /> 9 ► <br /> )-3 -04.0 1 ,S- <br /> 30.5 1f I b / <br /> oto 41.0 Vk <br /> b -Z <br /> . l S - <br /> .9- I o F <br /> AA 11010 -b S <br /> NOTES MISCELLANEOUS 7 - <br /> rt, Relinquished by (Signature) �celve re? Date Ttrge <br /> /Vf¢fi �go3� r F10 ut lme ed y (Signature) fi elv� Y �t a ate <br /> 794/ ire Sur Relinquished By (Signature) Received By (Signature) Date Time <br /> Method of Shipment Description of Other Chains-Of-Custody Despatched By (Signature) Date Time Received for lab By (Signature) Date Time <br /> Transport Con iner Transported with this <br /> ��� ti' - r'� Chain(by Servat No <br /> A <br /> Send Lab Results to (Name) 670a I' <br /> ,-,,� (Check Office Below) Verbals Requested Yes ®-'f�'D <br /> E] PORTER L� PLEASANTON ❑ IRVINE ❑ ATLANTA ❑ OTHER r <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)463-2961 FAX(714)757-0960 FAX(404)951-9364 FAX <br /> ❑ DENVER ❑ KING OF PRUSSIA ❑ HOUSTON ❑ MT VIEW ❑ OTHER <br /> TEL(303) 790-1747 TEL(215)337-2551 TEL(713)5581666 TEL(415)960-1640 TEL <br /> FAX(303)799-0186 FAX(215)337-0560 FAX(713)556.0666 FAX(415)960-0739 FAX I l <br /> CANONIE ENVIRONMENTAL SERVICES CORP ® 800 CANONIE DRIVE o PORTER, IN 46304 • TELEPHONE 219 926-8651 • FAX (219) 926-7169 <br /> SERIAL NO ^,T 5 <br /> r WHITE Field Copy YELLOW Protect Copy PINK Laboratory Copy <br />