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ENVIRONMENTAL CHAIN-OF-COST DY RECORD <br /> LAB PROJECT <br /> (See Reverse for Instructions) C35 (I(,°) (Z 3,s- Z NO `�;Z%/2 Z 9 <br /> PROJECT NAME T,/ <br /> SAMPLERS A L IF,. SAMPLE CONTAINER SAMPLE DESCRIPTION CODES --TA-T-60DES <br /> 1 (PRINT) '�--` J DESCRIPTION CODES A. Ground Water F. Oil / <br /> PROJECT NUMBER i(� 5 • C)oc)`' �_ —, I--Ir.&_4N,''. A. 40 ml VOA Vial B. Surface Water G. Waste \ 1. Standard 7 <br /> (SIGN) B. Glass Liter E. Brass Kube C. Leachate H. Blank/Spike -2.'48 Hour <br /> RECORDER C. Plastic 500-m1 F.Other I'�rY D. Rinseate 1. Other 3. 24 Hour <br /> (SIGN) D. Plastic Liter E. Soil/Sediment 4. Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS p ---- <br /> AND <br /> gg— og— PRESERVATION <br /> Y <br /> $ $ _ SAMPLE <br /> E� � _ LL— x/ ;� < ' a—o_ NOTES ASSIGNED CONDITION <br /> DATE TIME SAMPLE ID Z j.: I_t '}� ~ N i BOTTLE UPON <br /> UMBERS RECEIPT NOTES <br /> tt lt O �o nt1,,f- f v N - <br /> Ai <br /> - 1 - <br /> NOTES/MISCELLANEOUS , Relinquished by: (Signature) Receiv d By gnature) ate Time <br /> kt 1 )IZT UNL1 t)t..) t'2.60 { <br /> • / <br /> T 6 A ImTGI ei s <br /> 1 1 (�E 1 [.T[ 4 rA M� Rein had By: (Sign'tfl(r Received By: (Signal r ) Date Tima <br /> aK�GtE_IJt�.f`�s �t L H4 D1rI�ES� / ,..,� 1// � 3s <br /> Relinquished By: (Signature) Received By: (Signature) Date Tima <br /> Method of Shipment Description of Other Chains-Of-Custody Dispatched By: (Signature) �¢�e Time Received for lab By: (Signature) Date Time <br /> Transport Container Transported with this <br /> A w t`,tlx I E e Chain (by Serial No.) <br /> Send Lab Results to (Name): �ML; U Ad:C_ (Check Office Below) Verbals Requested: Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT. VIEW ❑ PORTER OTHER M61)t ST O <br /> TEL(404) 951-0055 TEL(303) 790-1747 TEL(714) 757-1755 TEL(415) 960-1640 TEL(219)926-8651 TEL 4r r�ei�l <br /> FAX (404)956-9364 FAX (303) 799-0186 FAX (714) 757-0960 FAX (415) 960-0739 FAX(219) 926-7169 FAX 7r_f--'577-``7; <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER______.____ <br /> TEL(406) 586-9496 TEL(713)556-1.666 TEL(215)337-2551 TEL(510)463-9117 TEL(503)241-0282 TEL _ <br /> FAX(406) 586-9724 FAX(713)556-0666 FAX(215)337-0560 FAX(510) 463-2981 FAX(503)241-0486 FAX <br /> VIRONMENTAL SERVICES, CORP. • 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 • TELEPHONE (303) 290-8336 • FAX (303) 290-8013 <br /> SERIAL NO. WHITE:Field Copy YELLOW:Project Copy PINK:Laboratory Copy REV 0/92 <br />