Laserfiche WebLink
PROJEdT <br /> CANONIE ENVIRONMENTAL #AIN-OF-CUSTODY RECORD . <br /> n /� h _(See R erre for Instructions) NO <br /> PROJECT NAME r �r n,� SAMPLERS A N) J�� �8 MA SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> L' DESCRIPTION CODES A Ground water t F Oil <br /> PROJECT NUMBER 7 3 ! � A. 40-ml VOA Vie[ B surface water G waste 1 Standard <br /> (SIGN) B Glass Liter E Brash Tube C Leachale H BlankJSpike 2 48 Hour <br /> RECORDER C Plastic 500-mi F Other b Rmseste I Other 3 24 Hour <br /> (SIl3NI D Pies tic Liter E Soil/Sediment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS o <br /> AND I <br /> PRESERVATION i A, qJ OA� i <br /> cS 4r � - 88 eY SAMPLE JJJ <br /> o J _ NOTES ASSIGNED CONDITION <br /> $ $ _ <br /> DATE T M BOTTLE UPON <br /> SA PLE IDV = v g' NUMBERS RECEIPT NOTES <br /> U;11 9T 11473 r-t W <br /> ^rF Yh ry ti S, <br /> LL <br /> t <br /> 1 <br /> NATES!MISCELLANEOUS _ Re1 ulshed by gnature) R�c e y �fure) DiteTime <br /> uis `By (Signature) Received By (Signature) Date Time <br /> vk'o A ivhc� Relinquished By (Signature Received By gnature) Date Time <br /> 1 <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 14 <br /> Chain (by Serial NO) a 7/205 <br /> 2 /y <br /> Send Lab Results to (Name) * If7 u -54 -7 (Check Office Below) Verbals Requested Yes D No <br /> r r` <br /> ❑ DALLAS ❑ DENVER I ❑ IRVINE ❑ MT VIEW ❑ PORTER OTHE�l <br /> TEL(214)770-1800 TEL(303) 790-1747 TEL(714) 757-1755 TEL(415)960-1640 TEL (219) 926-8651 TEL <br /> FAX(214) 770-0249 FAX(303) 799-0186 FAX (714) 757-0960 FAX(415)960-0739 FAX(219) 926-7169 FAX <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER <br /> TEL(406) 586-9496 TEL(713) 569-8686 TEL(215)337-2551 TEL(510)463-9117 TEL (503)2410282 TEL <br /> I+` FAX(406)586-9724 FAX(713) 531-8886 FAX (215)337-0560 FAX(510) 463-2981 FAX(503) 241-0486 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP • TWO GALLERIA TOWER -/13455 NOEL ROAD, SUITE 1500 - DALLAS, TX 75240 - TELEPHONE (214) 770-1800 - FAX (214) 770-0249 <br /> SERIAL NO O WHITE Fteld Copy YELLOW Project Copy PINK Laboratory Copy REV 11193 <br />