Laserfiche WebLink
t • CANONIE ENVIRONMENTAL&AIN-OF-CUSTODY RECORD .B PROJECT <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME 0-QAVk AN'2kl (Mk- SAMPLERS T&M SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> }� (P DESCRIPTION CODES A Ground water F Oil <br /> PROJECT NUMBER 0 Uvo ��,�� A 40-ml VOA Viat B Surface Water G Waste 1 Standard <br /> 1�/Ww Oe 4 (SIGN) B Glass Liter E Brass T C Leachate H then Spike 2 24 Hour <br /> RECORDER lfil.'A_�1�1� C Plastic 500.m1 F O[her S� D Rmseate I Other 3 24 Hour <br /> (SIGN) D Plastic Leer E So=Flsediment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS o <br /> AND <br /> —s$ PRESERVATION 9 �_ <br /> S$ ag g ;€ a _ SAMPLE <br /> NOTES ASSIGNED CONDITION <br /> T %;:14a° 176- BOTTLE UPON <br /> DATE TIME SAMPLE ID Tr ~ z NUMBERS RECEIPT NOTES <br /> 077 GG-591-Z.O X <br /> Cal l r- sig 1- ZS <br /> a 31 CG - .C19 E- 50 <br /> W-3 - S i- IS I,— 5 <br /> 1351 1 10 <br /> 1-405 - s$'1- IS <br /> NOTES 1 MISCELLANEOUS v_ OX ag, l �d�� � p�[.t F Rel (shed by (Signature) Receiv By a re) Date Time <br /> ,M"�S f 40!PC 1 !►7* / 1 Relinquished By (Signature) ecelved Sy (Signature) Date Time <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> QK))P— Qw"131010 AW <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 /> CoolR„r- r (OR 9 <br /> Send Lab Results to (Name) Qv\ (Check Office Below) Verbals Requested Yes ❑lNl`oC <br /> El ATLANTA 1:3 DENVER El IRVINE El MT VIEW ❑ PORTER OTHER M4 <br /> TEL(404) 9510055 TEL(303) 790-1747 TEL (714) 757-1755 TEL(415) 960-1640 TEL(219)926-8651 TEL�il'i f <br /> FAX(404) 956-9364 FAX (303) 799-0186 FAX (714) 757-0960 FAX(415)960 0739 FAX (219) 926-7169 FAX Z4 4 IM-Z-?-Z <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)2410486 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 14688 WHFTE Field Copy YELLOW Pro"Copy PINK Laboratory Copy REV 9192 <br />