Laserfiche WebLink
S ANONIE ENVIRONMENTA(','-HAI N-0 F-CUSTO DY RECORD AB PROJECT�) <br /> (See Reverse for Instructions) NO'- <br /> __ROJECT.NAME_e ^ &64— -_=SAMPLERS. AN �d __SAMPLE CONTAINER Al_ _SAMPLE DESCRIPTION_CODES _ TAT CODES r T <br /> f ( y f NT) DESCRIPTION CODE6— Ground water F. 64 5 <br /> PROJECT NUMBER T 6 Q r A, 40-mi VOA Vial B. Surlece Water G. Waste 1. Standard <br /> (SIGN) B, Glass Liter E. Brass Tube C. Leachate H. BlanklSpike 2. 46 Hour <br /> RECORDER C. Plastic Smml F.Other D. Rlnseate 1, Other 3. 24 Hour <br /> (SIGN) D. Plastic LBer E. SolilSediment 4, Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND W _ + <br /> gg PRESERVATIONYm 8Y <br /> RE`y m E N g SAMPLE <br /> & Z 1 NOTES ASSIGNED CONDITION <br /> BOTTLE UPON <br /> DATE TIME SAMPLE ID _ ( z NUMBERS RECEIPT NOTES <br /> 03011 1 V. il 131I <br /> 3479s 11 -7 t <br /> a39 ! d .M i+nw 3 13 \N1 <br />�I <br /> TT 44TT I I I <br /> NOTES 1 MISCELLANEOUS Relinquished y: (Signature) Re eI By: (Signatur ) Date Time <br /> f�I��,�p� _0-7D :Oo <br /> '� ' +tea"`{ +�►�C1�, <br /> Relinquishyd By: (Signature) Racelved (Signature) Date Time <br /> Relinquished By: (Signature) Received By: (Signature) Date Time <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 /> IL(26 0 1 CJI4�6_2� Chain(by Seriai No.) <br /> Send Lab Results to (Name): _4;3'"^ I�l! 0 '1N c,u, rT (Check Office Below) Verbals Requested: Yes i❑•,,N�o ❑ <br /> ❑ DALLAS ❑ DENVER ❑ IRVINE ❑ MT. VIEW ❑ PORTER OTHER "�"'�' <br /> TEL(214) 770-1800 TEL(303) 790-1747 TEL(714)757.1755 TEL (415) 960-1640 TEL(219)926-8651 TEL IrgIN"13f' 7s 0� <br /> FAX (214) 770-0249 FAX (303) 799-0186 FAX(714) 757.0960 FAX (415)960-0739 FAX(219) 926-7169 FAX&A V 2E. 3 ty <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER <br /> TEL (406) 586-9496 TEL(713) 589-8686 TEL(215) 337-2551 TEL(510) 463.9117 TEL(503)241-0282 TEL <br /> FAX (406)586-9724 FAX (713) 531-8886 FAX (215)337-0560 FAX(510) 463.2981 FAX(503)241-0486 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP. • TWO GALLERIA TOWER • 13455 NOEL ROAD, SUITE 1500 • DALLAS, TX 75240 9 TELEPHONE (214) 770-1800 • FAX (214) 770-0249 <br /> SERIAL NO. 21186 <br /> 'S+� al WHITE:Field Copy YELLOW:Project Copy PINK:Laboratory Copy REV. 11193 <br /> vn _ . _L.----- - <br />