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�\ 1 RECEIVED MAIC 1 b 1998 `I g0 l 3/ ' <br /> NTC AssvG(-"VTF-s /NC, NVIRONMENTAL CHAIN-OF-CUSTODY RECORD LAB PROJECT <br /> (See Reverse for Instructions) NO. <br /> PROJECT NAME 'LOIS . P>zoPECL-r�� SAMPLERS ALky, T-WR,6S SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> Q `� ow O w(PRINTy nR DESCRIPTION CODES A. Ground water G oil <br /> PROJECT NUMBER 11 IU`t• l T���It-�G.! tri.�Sl- A. 40.m1 VOA Vial B. Surface water G. Waste t. Standard <br /> (SIGN) B. Glass Liter E. Brass Tube C. Leachate H. Blank/Spike 2. 48 Hour <br /> RECORDER C. Plastic 500-ml F.Other D. Rinseate I. Other 3. 24 Hour <br /> (SIGN) D. Plastic Liter E. Soil/Sediment 4. Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> U <br /> o AND 9 8 a m <br /> m8. m PRESERVATION �^ mg $ mx�Y <br /> 3_ 08]e� <br /> LL ;E¢ ��_� SAMPLE <br /> ¢ NOTES ASSIGNED CONDITION <br /> em Em = LL �` 2 E o— BOTTLE UPON <br /> DATE TIME SAMPLE ID N N = NUMBERS RECEIPT NOTES <br /> 000 ✓ — <br /> ' <br /> 1410 <br /> T . . . <br /> NOTES /MISCELLANEOUS �(C /` S0. A �Q,,. V PO Y1) Relinquished b : (Signature) Ceive ;By: g to e) ate Time <br /> . AZI. AIEIJ • 10.E o��ct��`vQ1 v�1i o.y� ►,��tiro aG /a S <br /> �;Ir �rGser�e elfin u ed y: (S,i n1ature) eceived By: (Signature) Date Time <br /> �Icu�_ <br /> Relinquished By: (Signature) Received By: (Signature) Date Time <br /> C��oTr �• i3 <br /> Method of Shipment Description of Other Chains-Of-Custody Dispatched By: (Signature) Date Time Received for lab By: (Signature) Date Time <br /> Transport Container Transported with this <br /> Chain (by Serial No.) - 0226 <br /> Caul�E e'00(,E.R- N 72 f� //,30L- A <br /> )/;/'-/y49 1 y#0 <br /> Send Lab Results to (Name): Dre N VAAC_C ch/ (Check Office Be o ) V f als R quested: Yes ❑ No ❑ <br /> .❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT. VIEW , ❑ PORTER OTHER 7 <br /> TEL (404)951-0055 TEL(303) 790-1747 TEL(714) 757-1755 TEL(415) 960-1640 TEL(219) 926-8651 TEL709-_Sj�-aZ I <br /> FAX(404)956-9364 FAX (303) 799-0186 FAX(714) 757-0960 FAX(415).960-0739 FAX(219) 926-7169 FAX 2—(N <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KINd OF PRUSSIA ❑ PLEASANfON ❑ PORTLAND ❑ OTHER <br /> TEL(406) 586-9496 0 TEL(713) 556-1666 TEL{215) 337-2551 TEL(510)A463-9117 TEL(503)241-0282 TEL <br /> FAX (406)586-9724 FAX (713) 556-0666 FAXe15) 337-0560 FAX(510)'1463-2981 FAX(503)241-0486 FAX <br /> ENVIRONMENTAL SERVICES, CORP. • 6300 SOUTH fIACUSE WAY, SUITE 300 • ENG WOOD, CO 80111 • TELEPHONE (303) 290-8336 • FAX (303) 290-8013 <br /> SERIAL NO. 14651 WHITE:1=ield Copy YELLOW:Project Copy .Laboratory Copy REV.8/92 <br />