Laserfiche WebLink
Mr " CNROM ENMRdWEPAL AM-0�UMDf%ECMDPM M rROOR <br /> See Reverse 3br Instructions N <br /> PROJECT NAME jt� gQLM � � SAMPLERS NeX r,�,IzEs SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> I PRINT) DESCRIPTION CODES A Ground Water F Oil <br /> 9 <br /> PROJECT NUMBER / 5-r 1�1 a 1 �(� � A 40-ml VOA Vial B Surface water a waste t Standard <br /> (SIGN) a Glass Liter E Brass Tube C Leachale H BlanldSplke 2 48 Hour <br /> RECORDER C Plastic SOOmI F Other L�Lr�O� IUSedlment nseale I Other a Othe24 r <br /> (SIGN) D Plastic Liter R�Q <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS u <br /> AND $� <br /> — — PRESERVATION _ a <br /> SAMPLE <br /> d X NOTES ASSIGNED CONDITION <br /> BOTTLE UPON <br /> DATE TIME SAMPLE 1D UMBERS RECEIPT NOTES <br /> I 72 N <br /> �! a n - I � <br /> ro <br /> NOTES!MISCELLANEOUS Relinquished by (Signature) a elve y lgnature "D;e Time <br /> LA B r ( J Q7 &IJ Relinquished By (Signature) a elved Ely (SI tura) Dale Time <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> Method of Shipment Description of Other Chains Of Custody Dispatched By (Signature) Date Tlme Received for tab By (Signature) Date Time <br /> Transport Container Transported with this <br /> �2�r%kj�. &UttCQ� Chain(by Serial No) <br /> �IZa9 �- � <br /> Send Lab Results to (Name) (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ DALLAS ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER OTHER <br /> TEL (214) 7701800 TEL(303) 790-1747 TEL(714) 757-1755 TEL(415)960-1640 TEL(219)926 8651 TE <br /> FAX (214) 770 0249 FAX(303) 799 0186 FAX(714) 757-0960 FAX (415) 960-0739 FAX(219) 926 7169 FAX 2 S <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER , <br /> TEL(406) 566 9496 TEL(713) 589 B686 TEL (215)337-2551 TEL(510)463-9117 TEL(503) 2410282 TEL <br /> FAX(406) 566 9724 FAX(713) 5318886 FAX (215) 337 0560 FAX (510) 463-2981 FAX(503) 241-0486 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP a TWO GALLERIA TOWER a 13455 NOEL ROAD, SUITE 1500 a DALLAS, TX 75240 a TELEPHONE (214) 770-1800 a FAX(214) 770 024$ <br /> SERIAL NO 211 <br /> 11 S q WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV IIJ93 <br />