Laserfiche WebLink
CANONIE ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LAB PROJECT <br /> IJI I (See Reverse for Instructions) NO.$3 %7_ <br /> PROJECT NAME ne r-A21 1 U21"Jce �J�o SAMPLERS IGei`' fEe�{�i SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> r,�{ <br /> (PRI DESCRIPTION_ DESCRIPTION CODES A. Ground Water F. Oil <br /> PROJECT NUMBER (J��`� ) r ati //. A. 40-ml 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 C. Plastic 500-ml F.Other D. Rinseate I. Other 1 24 Hour <br /> (SIGN) D. Plastic Liter E. Soil/Sediment 4. Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND <br /> O - <br /> g—-E— PRESERVATION $ (l' C� � � $g— <br /> LL I 9 >e a SAMPLE <br /> NOTES ASSIGNED CONDITION <br /> DATE TIME SAMPLE IDS LL0- <br /> 1j) BOTTLE UPON <br /> {� LU NUMBERS RECEIPT NOTES <br /> _<7 esu A <br /> 0 <br /> a <br /> s <br /> �`le <br /> NOTES MISCELLANEOUS �b/\r elinquished ly: (Si�g�,ature) epei may: (Sig ►ur�e� ^� 5/Date Time <br /> .r r/ I j tf1' (� .�� 9d vWA,11 <br /> Relinquished By: (Si Lure) Received By: (Signature) Dale Time <br /> S-t-,Dc,k+otJ 0_4 , SSaaS <br /> s " Relinquished By: (Signature) Received B Ignatu to Time <br /> Method of 9hipmot Descriptionof Other Chai s- -Custody Dispatched By: (Signature) Date Time Re eive or lab By (S nature) Date, Time <br /> A n Transport Container Transported with this <br /> Chain(by Serial No.) � <br /> Send Lab Results to (Name): (Check Office Below) Verbals Requested: Yes ❑ No ❑ <br /> ❑ PORTER ❑ SAN MATEO ❑ IRVINE ❑ ORLANDO ❑ OTHER <br /> TEL (219)926-8651 TEL(415) 573-8012 TEL(714)757-1755 TEL(407)856-7428 TEL <br /> FAX (219) 926.7169 FAX (415) 573-5654 FAX(714)757-0960 FAX(407)855-2595 FAX <br /> ❑ DENVER ❑ KING OF PRUSSIA ❑ HOUSTON ❑ MT: VIEW ❑ OTHER <br /> TEL (303) 790-1747 TEL (215)337-2551 TEL(713) 556-1666 TEL(415)960-1640 TEL <br /> FAX (303) 799-0186 FAX (215)337-0560 FAX(713)556-0666 FAX(415)960-0739 r FAX <br /> CANONIE ENVIRONMENTAL LABORATORY • 212 FRANK WEST CIRCLE, SUITE A • STOCKTON, CA 95206 • TEL.(209) 983-1340 • FAX (209) 983-0304 <br /> SERIAL NO. O 4 O WHITE:Field Copy YELLOW:ProjeckCopy PINK:Laboratory Copy <br />