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'J <br /> E <br /> Lp,t3 R4JECT <br /> CANONIE ENVIRONMENTAL CH Afi`t�0E-CUSTODY RECORD NO.— <br /> (SeeReverse for Instructions) � 2 TAT CODES <br /> A ,�} Irylovld �hlD[' _ u ,_ SAMPLEnS�' / 'v'L r SAMPLE CONTAINER SAMPLE DESCRIPTION CODES <br /> ti- OJECT NAME .�.�--V�--- y{u+JT1 —N pESCRIPTIaPI CODES 11 cr«wwziai G.waste r ""I lad <br /> (1E"{ A 4o-mf VOA VVaI U.uuil+ce Warel <br /> .L."Wke N Ui�nv pus 7.4611at <br /> O,IECT NUMBER U'SiC,r:i C Pla L LNur F t11 -T.L.e� p n n�e.ra. L ouwr V— a. 21 <br /> Neu+ <br /> _ �- C F'lulrc 504M r,OU�-i_— [. S�u:;W�muN A.Omer <br /> RECORDER- u.PWIC user <br /> {s�Gr+I LABDRATORY USE ONLY <br /> -,Iumel loF ANALYSIS REQUESTED <br /> HTANERS yI <br /> l ANO y- <br /> ;_s; er;esEtrrAlsw+ Y_ V1 3i3 33 A� ge=l n: SAMPLE <br /> E E6? <br /> NOTES ASSIGNED GOUP€OTN N <br /> BOTTLE tea - NUMBERS RECEIPT NOTES <br /> DATE TIME SAMPLE 10 , 1 <br /> 2S 1 r O$ <br /> !I / Lf r d <br /> f / 3` g A,8 <br /> 0 g Rr <br /> XX Flt3 r <br /> o <br /> at re) Received By:(Sigrwture) Gate Time <br /> I qu ed by , <br /> —WO—TES f MISf�ELLANEOUS %. �� Delo Time <br /> /7190-Mel rJ,4 S�� `.C�Sf r Z4 �, dam° r �i. ry u had By:(Si natur6) Retoivod ey:(Signature] <br /> W i • <br /> CArg 4Pk1S <br /> i�1G • RA MMTap�t�Jes�►+! ci Received By:(Signature) Date Time <br /> P.O. By:(Signature}coqi. <br /> ,5!Wk73a1 CA S201 <br /> re Qa1e <br /> Received for lab B Dato Time <br /> Time <br /> Method of Shipment Description o! Other Chains-7f-Custody Dispatched By:(Si gnatu ] <br /> Transport container TransCha n�y Serted r it this <br /> }' <br /> 53"S- , V al$ Requested:Yes ❑ No ❑ <br /> � C7p0—LG--L1- et Alf �� � (Check Office Below) <br /> Rend Lab Results to(Name): ❑ ORLANDO ❑'•OTHER <br /> ❑ SAN MATEO ❑ €RVINE TEL(407)656-7428 TEL�-�-- <br /> ❑ PORTER TEL(415)573-9012 TEL(714)757-1755 FAX(407)855.2595 FAX-�� <br /> TEL(219)926.9651 FAX(415)573-5654 FAX(714)757-0960 <br /> FAX(219)926.7169 ❑ MT.VIEW U OTHER <br /> I ❑ KING OF PRUSSIA ❑ HOUSTON TEL(415)9601640 TEL --- <br /> ❑ DENVER f TEL(215)337.2551 TEL(713)556-0 65 FAX(415)960-0739 FAX � <br /> TEL(303)7901747 ( FAX(215)337-0560 FAX(7t3}5560666 <br /> FAX(303)799-0t9fi i <br /> CANi]NlE GNVlRDNMEhiTAL(p BOiRATORY - 212—F—NK V1 ESIRC rE�A �STD PI ..,CW Cr 06 TEL.(209)983-1340 FAX IlQ9 983-0304 <br />