Laserfiche WebLink
�Cr � <br /> S .f ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD 7 3L i PROJECT <br /> (See R verse for Instructions) ����(, NO <br /> _ -- <br /> PROJECT NAME T'A (vte 1z.i-PWP"e-7'1 SAMPLERS FlY ` Ids SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> 1 Uzi <br /> P INT) DESCRIPTION CODES A Ground Water F Oil <br /> PROJECT NUMBER 6259 G•oval 01 ?4 z -� 1 A 40-mi VOA Vial B Surface water G Waste 1,Standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H Biank/Spike 2 48 Hour <br /> RECORDER C Plastic 50o ml F Other D Rmseate E Other a za hour <br /> (SIGN) D Plastic Liter E SoitfSedimeni 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS e <br /> AND <br /> g o^ PRESERVATION <br /> 8 LL cox} Sx SAMPLE <br /> gp �' NOTES ASSIGNED CONDITION <br /> rm s °>- BOTTLE UPON <br /> DATE TIME SAMPLE ID LkrB r a 44 = l 1 C i l NUMBERS RECEIPT NOTES <br /> E:..`1i 4 "- 1 11 - V I V1 C (,/IV <br /> -2 IF 7 S MW 3 -I bAlml lid, <br /> t .4 <br /> tr: 1r RNs 11 I:t., , Lf 14I/ J <br /> 11 k L- Nz <br /> NOTES I Mi CELLA EOU T 4 ti Rolmqulsh!sy (Signature) R �d B nature) D #e Time <br /> f� A-Ir !i~�" #L Sc� (tL �,r T! T 7,,.�' .. ��{ aU6' <br /> �- d �'Ce� • w� Kit ellnq y (Signature) s ecervi3d By (y5lgna ure) Date Time <br /> zf 9-700q8 <br /> � 4�y� Relinquished By (Signature) Received t3y (Signature) Date Time <br /> Method of Shipment Description o Other Chains-Of-Custod Dispatched B (Signature) Date Time Received for lab B (Signature) Date Time <br /> AY P Y ( 9 ) Y E 9 ) <br /> Transport Container Transported with this <br /> Chain (by Serial �] <br /> l)rlkt (L CO0t-�.L>— I 'y1()�11 f <br /> Send Lab Results to (Name) �'� A0 U-F-t-J (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> 7-69 5179-4,112 <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER OTHER ire+� 79. <br /> TEL(404) 9510055 TEL(303) 790-1747 TEL(714)7571755 TEL(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 /> �❑ -P ZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER <br /> L(406)566 9496 TEL(713) 556-1666 TEL(215) 337 2551 TEL(510)463-9117 TEL(503)2410282 TEL <br /> (406)5869724 FAX (713) 556-0666 FAX (215) 337 0560_ FAX(510)463 2981 FAX(503) 2410486 FAX <br /> lE ENVIRONMENTAL SERVICES, CORP • 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 • TELEPHONE (303) 290-8336 • FAX (303) 290-8013 <br /> Q 7 A I WHITE Field Copy YELLOW Protect Copy PINK Laboratory Copy REV W92 <br />