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CANONIE ENViht)NMIEN' f,AL dIHAIN-OF-CUSTODV RECORD LAB PROJECT <br /> ` (See Reverse for Instructions) NO. <br /> PROJECT NAME ACE K T-I <br /> SAMPLERS SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> PROJECT NUMBER _ (I f 1 U CtrRI. DESCRIPTION CODES-,A-.; A. Ground water F. Orl <br /> {� A. 40.ml VOA Vial <br /> B. sudac9 water G. waste ,. Standard <br /> (SIGN) B. Glass Liter E. Bross Tube C. Leachate H. Blank/Splke 2. 49 Hour <br /> RECORDER 0:.Plastic soo-ml'F.'Other... 'D- Rinseats'- - `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 <br /> afi AND <br /> m S, PRESERVATION <br /> t 4 W € ti^ SAMPLE <br /> DATE TIME $� $$ i J r $ a NOTES ASSIGNED <br /> CONDITION <br /> ''r' I j <br /> SAMPLE IDT 3 -� NUMBERS RECEIPT NOTES <br /> S - W- 1A A - I <br /> :> z OAt, 1 IRC E <br /> s A t <br /> I . <br /> Ir PI, 17-60 <br /> �-- <br /> ------------- <br /> 1 <br /> NOTES/MISCELLAN7OUS <br /> Relinquished by: (Signature) a elved :S i n9ture) at TI e <br /> Relinquished By: (Signature) Received By: (Signature) Date Time <br /> r <br /> Relinquished By: (Signature) Received By: (Signature) Date Time <br /> Method of ShipmenDescription of Other Chains-01-Custody Dispatched By: (Signature) Date Time Rece. d for b y: (Signature Date Time <br /> n nsport Container Transported with this - J <br /> �>PE li�ilt r Chain (by Serial No.) 1 Z 3 <br /> f .„OrJll Send Lab Resume): I�!l��r (SMS%.. <br /> (Check Office Below) Verbals Requested: Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE r ❑ MT. VIEW ❑ PORTEROTH <br /> TEL(404)951 TEL (303) 790-1747 ER '��� <br /> 0055 TEL(714) 757.1755 TEL(415) 960-1640 TEL(219)926-6651 TEL . <br /> FAX (404)956-9364 FAX (303) 799-0166 FAX (714)757-0960 FAX (415)960-0739 FAX (219) 926-7169 FAX j <br /> LD 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) `^..-9724 FAX (713) 556-0666 FAX 215 337-0560 <br /> ;rn� NlE �, �ir<a ( ) � FAX (510) 463-2961 � . FAX(503)241-0466 FA" <br /> _ _ O TA[ cam: VICE RP - fl0 G,,I rT SYr, .,,., SO 0 • �---� CO r . T. HOS 3 2 3ti • - 8015 <br /> .5 6 <br />�E ` <br /> Ei11AL�N a�irJ � -.J -----�.. .._:. EW(--w�--�' ' <br /> WHITE;Field Copy YELLOW;P:olett Copy PINK:Leboralory Copy REV.BFJ2 <br />