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MCAR%NFMNft0ME9%L *AllF-� S�Y�C�DM M 0MOAM <br /> (See Reverse for Instructions) <br /> NO <br /> PROJECT NAME !#I i VI C.E SAMPLERS ~5 SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (P DESCRIPTION CODES A Ground Water F Oil <br /> PROJECT NUMBER�y-37"'x_ 9d A 46m1 VOA Vial a Surface water G waste 1 Standard <br /> (SIGN) B Glass Liter E Braes Tube C Leachate H Blank/Sptke 2 48 Hour <br /> RECORDER C Plastic 500-mt F Other o Rlnsoate I Other 3 24 Hour <br /> (SIGN) D Plastic Lifer E SolllSedimeM 4 Other <br /> NUMBER OF ANALYSIS REQUESTED <br /> CONTAINERS LABORATORY USE ONLY <br /> ANO <br /> e <br /> PRESERVATI N IY $ <br /> c3itx <br /> � Y SAMPLE <br /> $t x J ff€ t _ NOTES ASSIGNED CONDITION <br /> DATE TIME SAMPLE ID v co NUMBERS RBOTTLE ECEIPT NOTES <br /> o tit Mw-ti a A ✓ < % ✓ <br /> OV1,9s 11 w- Ar <br /> 6%1 bQ ✓ ,/ t ,� ✓ <br /> �. <br /> p$3b9 ryS'b W- A A ✓ ✓ 1 <br /> Oglbg ty I�w -5 A 3 I ✓ v <br /> 61916 I mw- A A 1 <br /> ke <br /> -------------- <br /> ----------------- <br /> -————————————— <br /> NOTES l MISCELLANEOUS �LG ASE �� Relinquished by {Signature) Received By (Slgnatur Date Time <br /> Lig <br /> Ae16081 <br /> c r1 Moa I c.r 1,ABS.. &' MPLES T+�M P. , <br /> Relinquished By (Signature) Received By (Signature) Date Tlme <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> r�"' � U n 1a� Gm- S <br /> Method of Shipment Description of O her Chain Of-Custody Dispatched By (Signature) Date Time Received for lab By (Signature) Date Time <br /> AGfa Transport Container Transported with this <br /> Chain (by Serial No) <br /> Ip 6 Ssa <br /> Send Lab Results to (Name) %Jr A-NN G SL'1. (Check Office Below) Verbais Requested Yes ❑ Na ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER JLI OTWER LQJ�-� <br /> TEL(404)951-0055 TEL(303) 7901747 TEL(714)757-1755 TEL(415)960-1640 t TEL(219)926-8651 TEL <br /> FAX(404)95&9364 FAX(303) 799-0186 FAX (714) 757-0960 FAX(415)960 0739 FAX(219)926-7169 FAX ¢- fQg <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) 2410282 TEL <br /> FAX(406)5869724 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 <br /> SERIAL NO 18693 - WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy <br /> REV 8192 <br />