Laserfiche WebLink
M Mr M CROW MtIRMMFiWA HAI-CWCU%TOffmRft'bRf" ' PFMT <br /> See Reverse—for Instructions0-1 <br /> 1 <br /> PROJECT NAME X-9M T9062&TY SAMPLERS_ALEX �FZOR-E'— SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PRINT) DESCRIPTION CODES A Ground Wafer F Od <br /> PROJECT NUMBER-15— I A 40-ml VOA Vial B surface water G Waste 1 Standard <br /> (SIGN) 8 Glass Liter E Brass Tube C Leachate H Blank/Spike 2 48 Haut <br /> RECORDER C Plastic 500-mi F Other p Rlnseals I Other 3 24 Hour <br /> (SIGN) 0 Plastic Litar E SoIl/Sadimenl 4 Olher <br /> NUMBER of ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND $^ + <br /> PRESERVATION 8 a° <br /> € t SAMPLE <br /> NOTES ASSIGNED CONDITION <br /> BOTTLE UPON <br /> DATE TIME SAMPLE tDv Z NUMBERS RECEIPT NOTES <br /> a� 25 �WA P1 I vrq v DAVIV <br /> 6 ?-OQ1 r <br /> q D M W. v I r <br /> r 10 <br /> NOTES I MISCELLANEOUS 2>p $ Relinquished by (Signature) Received By,(Signature Date Tlrpe� <br /> „ p T+ t`TtRTCr` �ltaU YJ c..r l% ry �'L •S�tme <br /> LtR tD ; SEQtso -A Ot` Relinquished By (Signature) Rece By (Slgnawre) Date <br /> � I <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> i <br /> Method of Shipment Description of Other Chains-Of-Cuslody Dispatched By (Signature) Dale Time Received for lab By (Signature) Date Time <br /> Transport Container Transported with this <br /> Chain(by Serial No) <br /> P- Am 1 IOD - <br /> Send Lab Results to (Name) JC E (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ElATLANTA ❑ DENVER ElIRVINE ElMT VIEW ElPORTER OTHER MODSrQ <br /> TEL(404) 951-0055 TEL(303)790-1747 TEL(714) 757-1755 TEL(415) 960-1640 TEL(219)926 8651 TEL - Z( <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 /> TEL(406)586-9496 TEL(713)556.1666 TEL(215)337-2551 TEL(510) 463 9117 TEL (503)2410282 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 6336 • FAX 303 290-6013 <br /> SERAIL NO � r � � �+ WHITE Field Copy YELLOW Protect Copy PINK Laboratory <br /> Copy REV 8!'Jl <br /> I r� <br />