Laserfiche WebLink
0 0 <br /> CANONIE ENVIRONMENTAL AIN-OF-CUSTODY RECORDWROJECT <br /> (See Reverse r Instruc#Ions) NO ' <br /> PROJECT NAME �>T�+ ir_ 6' I)I IST SAMPLERS A LF N "� Cnlc c SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> _ (PRINT) /` DESCRIPTION CODES A Ground Water F oil <br /> PROJECT NUMBER I 7)-7"`, C) i - !0 ?Cf Q ,r _ �7�'� -h I 1 A 4D ml VOA Vial B Surrace Water G waste 1 Standard <br /> (SIGN) R Glass Liter E Brass Tube C Leachate H Blank/Spike 2 48 Hour <br /> RECORDER C Plastic 500 ml F other p Rmseale I other 3 za Hour <br /> (SIGN) D Plastic Liter E SodlSedlment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS l <br /> m `g j� <br /> AND <br /> PRESERVATION <br /> =� <br /> mY I� mB 98 v <br /> 3 E¢ Nc`�i m� SAMPLE <br /> a5 NOTESASSIGNED CONDITION <br /> Em am a 2 �� a` z E 0— <br /> BOTTLE UPON <br /> j DATE TIME SAMPLE ID 5 ry ; z NUMBERS RECEIPT NOTES <br /> -704001 <br /> t�� r <br /> i <br /> i <br /> i <br /> NOTES!MISCELLANEOUS Relinquished by (Signature) Received By (Signature) Date Time <br /> Relinquished By (Signature) Received By (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 /> (-,I ()I� Chain (by Serial NO) <br /> I <br /> Send Lab Results to (Name) -� _ (Check Office Below) Verbals Requested Yes 1:1No 12"' <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTEROT,— <br /> LA!' OTHER /ZJ/1/?l`=S%fJ <br /> TEL (404) 951 0055 TEL(303) 790 1747 TEL (714) 757 1755 TEL(415) 960-1640 TEL(219) 926 8651 TEL;a�—r i'!' i / <br /> FAX (404) 956 9364 FAX(303) 799 0186 FAX(714) 757 0960 FAX(415) 960 0739 FAX (219) 926 7169 FAX-)1) 71- <br /> , <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) 586-9724 FAX (713) 556 0666 FAX (215) 337 0560 FAX (510) 463 2981 FAX (503) 2410486 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 14 5 3 <br /> WHITE Feld Copy YELLOW Protect Copy PINK Laboratory Copy REV 8192 <br />