Laserfiche WebLink
ti <br /> CIE ENVIRONMENTA IAIN-OF-CUSTODY RECORD I PROJECT <br /> (See Revers."--. Instructions) �T? <br /> PROJECT NAME ��� lE� t`C � -�y ►�LC?C �j(}12� s <br /> >Y I f SAMPLERS SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> e F (PRINT) I ' �}DESCRIPTION CODES A Ground water F Ott <br /> PROJECT NUMBER ~ { ' 4 �`"' rA 46mf 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 /> C Plastic 500-m1 F Other D Rmseate I Other 3 24 Hour <br /> RECORDER (SIGN) I D•Plastic Liter E Soil/Sediment 4 Other <br /> 1 <br /> NUMBER OF ALYSIS�REQUESTED t LABORATORY USE ONLY <br /> CONTAINERS <br /> c AND t• r S' °v i r <br /> o <br /> n— hTPRESERVAION + <br /> SAMPLE ,F <br /> 1(E mt° 50 , m �$ a o" NOTES ASSIGNED CONDITION <br /> • s , BOTTLE UPON <br /> DATE TIME SAMPLE IDYvPA I Z NUMBERS RECEIPT NOTES <br /> 0 i l <br /> 0°a ;; I <br /> 703 i_ 00i CANUA-'6WELL., <br /> T" � <br /> t _ t <br /> k f <br /> p <br /> r <br /> r + <br /> s � <br /> NOTES!MISCELLANEOUS Y , � �Rellnquls��(Signature)," Re Ived By (Signal e S to Time <br /> r <br /> t . - <br /> RelmqulsheWS ure) RecWtd By (Signature) Date Time <br /> Reimquished By (Signature) Received By (Signature) n 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 /> II Transport Container Transported with this { ri ` <br /> �l�1.� r �} , <br /> _ Chain (by Sinal No) <br /> ell <br /> Send Lab Results to (Name) (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ ATLANTA tO DENVER ❑ IRVINE ❑ MT VIEW , ) ❑ PORTERHER / <br /> TEL (404)551-5055 TEL (303)790-1747 , TEL(714)757-1755 TEL(415)960 ifi40 TEL(219)926 8651 r�f TEL <br /> FAX(404) 956-9364, FAX(303) 799-0186 FAX(714) 757-0960 t " FAX(415)960-0739 > FAX(219)926.7169 ;, ,r F <br /> ❑ BOZEMAN ❑ HOUSTON ;, ❑ KING OF PRUSSIA r' ❑ PLEASANTON ❑ PORTLAND, t Lit r ❑ OTHER <br /> TEL(406) 586-9496 TEL(713) 556-166fi Y TEL(215)337-2551 TEL (510)463-9117 TEL(503)241-0282 - ,� (_ TEL <br /> FAX (406)586-9724 t 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 J WHITE Field Oopy YELLOW Project Copy PINK Laboratory Copy REV W2 <br /> 145 <br /> t" <br />