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r S <br /> '09 -M M ism M 'm M Im <br /> VHIVVIVIC CIV V IlfiV1VIVICIV l Hf7HIIV-VI'-l.V 7 1 VU Y t~iCI.VI'[U trr, <br /> ] <br /> (See Reverse for Instructions) NO. <br /> PROJECT NAME SAM PLERS��70 .� SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> Q�� (PRI DESCRIPTION CODES round water F. oil <br /> PROJECT NUMBER 94-` ��3 t'"�` {� A. 46-m)VOA Vial B. surface water G. Waste 1. Standard <br /> ( G B. Glass E. Brass Tube C. Leachate H. BlanlUSpike 2. 48 Hour <br /> RECORDER_ C. Plastic F.Other D. Rinseals I. Other 3. 24 Hour <br /> {S1GN) D. Plastic0 Llte E. Soil/Sediment 4. Other _ <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND S <br /> : - PRESERVATION Y g o o <br /> 4 gr a SAMPLE <br /> ! �e ~? a-o� NOTES ASSIGNED CONDITION <br /> DATE TIME SAMPLE Ib BOTTLE UPON <br /> h Z NUMBERS RECEIPT NOTES <br /> 0 •- / <br /> 10.110 <br /> ! <br /> ha <br /> .,f�-�� 5 <br /> NOTES/MISCELLANEOUS <br /> Relinquished b (Si afure} Rec ID <br /> i nature Data Time <br /> p foo f5 <br /> elln is ed By ignature) Received y: (Signature) Date Time <br /> elfin uishe ��In 45 <br /> q (Signature) Received By: (Signature) Date Time <br /> Method of Shipment Description of Other Chains-Of-Custody Djs had By: (Sig ur Date Time Received for lab By: (Signature) Dai Time <br /> C W n�� <br /> Trans <br /> rt Container Transported with this <br /> Chain (by Serial No. <br /> 4 _ <br /> 1 <br /> Send Lab Results to (Name): (Check Office Below) Verbals Requested: Yes No El <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE MT. VIEW ❑ PORTER ED OTHER <br /> TEL(404) 951-0055 TEL(303)790-1747 TEL(714) 757-1755 XTEL (415) 960.1640 TEL (219) 926.8651 TEL <br /> FAX(404) 956-9364 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 /> t TEL (406) 586-9496 TEL(713)556-1566 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 60111 • TELEPHONE (303) 290-8336 • FAX 303 290-9013 <br /> SERIAL NO, A q q n Q WHITE:Field Copy YELLOW:Project Copy PINI(:Laboratory Copy REV.&92 <br />