Laserfiche WebLink
ENVIRONMENTAL (: .,.,,AIN-OF-CUSTODY RECORD �: ' _�.PRo���=T <br /> (See Reverse for Instructions) NO.1 <br /> PROJECT NAME euxO SNI Ink 63�WAL SAMPLERS Ares 71or4eS SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> �( (PRINT) DESCRIPTION CODES A Ground Water F_ Oil <br /> PROJECT NUMBER 62S7`�- 0000- N A. 40-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 500-m1 F Other D. Rinseate I. Other 3. 24 Hour <br /> (SIGN) D. Plastic Liter E. SoiNSediment 4. Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND <br /> m�n PRESERVATION mx _ g m V n^ <br /> 8� o° ;E� 2. SAMPLE <br /> o cc s l F . a� NOTES ASSIGNED CONDITION <br /> rm <br /> m- Em a = LL4 ` E ° BOTTLE UPON <br /> DATE TIME SAMPLE ID N N Z NUMBERS RECEIPT NOTES <br /> Ologlat 20t ✓�- <br /> 165 - V�-1. �/ ✓r <br /> 122 W - t ✓ � <br /> oca 5 W�5 +< <br /> X09 ro Innlhi— <br /> NOTES!MISCELLANEOUS Relinquishe Signature) Received By: (Signature) Date Time <br /> Relinquished By: (Signature) Received By: (Signature) Date Time <br /> Relinquished By: (Signature) Received By: (Signature) Date 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 /> Chain (by Serial No.) <br /> Send Lab Results to (Name): FA, tiv&Se (Check Office Below) Verbals Requested: Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT. VIEW ❑ PORTER OTHER &OOFs1 d <br /> TEL(404)951-0055 TEL (303) 790-1747 TEL(714) 757-1755 TEL(415)960.1640 TEL (219) 926-8651 TEL �Z <br /> FAX(404)956-9364 FAX (303) 799-0186 FAX(714) 757-0960 FAX(415)960-0739 FAX(219) 926-7169 FAXZ69- <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. WHITE:Field Copy YELLOW:Project Copy PINK:Laboratory Cops' REV.8192 <br />