Laserfiche WebLink
J , <br /> -GANONIE ENVIRONMENTAL :CHAIN-OF-CUSTODY RECORD LAB PROJECT <br /> (see Reverse for Instructions) NO.' <br /> PROJECT NAME I ✓��PQ Y�`� SAMPLERS I QWl ✓vK", I SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> o C) (PRINT) DESCRIPTION CODES A. Ground Water F. Oil <br /> PROJECT NUMBER C) ' I l)t, A. 40in[VOA Vial B. Surface Water G. Waste 1. Standard <br /> �� (SIGN) B. Glass Liter E. Brass Tube C. Leachate H. Blank/Spike 2. 48 Hour <br /> RECORDER J��� C. Plastic 500-m1 F Oil r D. Rinseale I. Other_ 1 24 Hour <br /> D. Plastic Liter Amt -V4. �1L- E. SoillSedimenl 4. Other_ �� �`cq S <br /> (SIGN) --- -. __— -- ---— <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY _ <br /> CONTAINERS -- <br /> g AND $ ' <br /> 9£— g PRESERVATION $ d g $_ <br /> b 8 ¢ O a33$ a _ SAMPLE <br /> E� $� = LL- y a" a-o_ NOTES ASSIGNED CONDITION <br /> DATE TIME SAMPLE ID 1� e ' BOTTLE UPON <br /> Z NUMBERS RECEIPT NOTES <br /> NOTES/MISCELLANEOUS Relinquished by: (Signature) Received By: (Signature) Date Time <br /> t-�4.�'� A� ©���� Q�'9-l-ody B - <br /> tz�Z ►2��o`I� OAN, pX pptv�a�L �trt� QGIC13tJ'�S • Relinquished B (Signature) Received B (Signature) Date Time <br /> ^�T11 IE1 f— t + t PL� , ME , TA A <br /> Relinquished By: (Signature) Received By: (Signature) Date Time <br /> I <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.) <br /> Send Lab Results to (Name): C— aQ� �--- (Check Office Belp' ) Ver lls Requested: Yes ❑ No,L3'� <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT. VIEW ❑ PORTER 14 OTHERAA10t=-1'_ <br /> TEL(404) 951-0055 TEL(303) 790-1747 / TEL(714)757-1755 TEL (415) 960-1640 TEL(219) 926-8651 TELT? Z 1_Z I <br /> FAX (404)956-9364 FAX (303) 799-0186 FAX (714) 757-0960 FAX (415) 960-0739 FAX (219) 926-7169 FAXi!�__?Z 2 <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)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 /> CANONIE ENVIRONMENTAL SERVICES, CORP. • 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 • TELEPHONE (303) 290-8336 • FAX (303) 290-8013 A <br /> SERIAL NO. 4 <br /> ; 9 ` WHITE:Field Copy YELLOW:Project Copy PINK:Laboratory Copy REV h/92 <br />