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1• _ !V C VI V I �:I' IV b&C:� VN& HWjFf ty t'NW6I <br /> ( ee Rev or Instructions) <br /> PROJECT NAME &&M SAMPLERS IOP -7013-fs SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> T _ - - ! DESCRIPTION CODES A (around Water F Oil <br /> PROJECT NUMBER� '_a� �� Q a� ` G fi 7({ N A 40-ml VOA vial B surface Water G Waste i Standard <br /> or r— <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H Blank/Spike 2 48 Hour <br /> RECORDER _ C Plastic 500ini F Other D Rtnseate I Other 3 24 Hour <br /> (SIGN) D Plastic Liter E SolUSedimeni 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND <br /> PRESERVATION <br /> SAMPLE <br /> a v _ � NOTES ASSIGNED CONDITION <br /> �V > BOTTLE UPON <br /> DATE TIME SAMPLE ID A z° NUMBERS RECEIPT NOTES <br /> 9 2 I I pq v of <br /> 6ZD I 02 <br /> 4 Mw N r <br /> R4= IU <br /> pi F w <br /> ...wf <br /> t <br /> NOTES t MISCELLANEOUS Relinquished by (Signature) Receive B (Signatur Date Tipep <br /> PfCurs <br /> TX�-MPEZRATuac- VMP..) <br /> LA Q : SIF&Uo IA 9414 V►oi, a quis d B (Signature) Rece d By (Slgnature) Date Time <br /> F Relinquishe By (Signature) Received By (Signature) Dale Time <br /> i <br /> Method of Shipment Description of Other Chains-01-Custody Dispatched By (Signature) Date Time Received I lab By (Signature) Date Time <br /> Transport Container Transported with this <br /> �1 Chain (bySerial No)MT pow, <br /> Senn Lab Results to (Name) JC #- (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER V,O,HER <br /> TEL(404)9510055 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 � � JAX,(2191926-7169 FAX i <br /> N 'L V� ,1+� 4 r • bY7M!tl,!'h�Y /�itYv Y�1wy��►� <br /> ❑ BOZEMAN ❑ HOUSTON y ❑,HINGloF f�RU§SEA ^ ❑ PLEASANT f) r 'MRTMD ❑ OTHER <br /> T (406) 586-9496 TEL(713)556.1666 TEL(215)337-2551 TEL(510)463 9117 rel L(503)2410282 TEL <br /> F (406) 5B6-9724 FAX(713)556-0666 FAX(215) X37-0560 a FAX(510)463-2981 (593)241-0486 FAX <br /> GAN IE ENVIRONMENTAL SERVICES, CORP • 6300 SOUTH SYRACUSE AY, SUITE 300 • ENGLEWOOD, CO 80111 • TELEPHONE 303 2908336 • FAX (303) 290-8013 <br /> SERIAL NO 1 r—Ti P WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV IA2 <br />