Laserfiche WebLink
I S. <br /> CANONIE ENVIRONMENTAL AIN-OF-CUSTODY RECORD PROJECT <br /> (See Reverse for Instructions) NO `' <br /> t115 SER+I�C c SAMPLERS SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> PROJECT NAME 1441F- AIS- - <br /> (PR1NT) DESCRIPTION CODES A Ground water F 04 <br /> PROJECT NUMBER 4-37 3 0 1-19- � A 40 m1 VOA Vial 8 Surface Water G waste I Standard <br /> {SIGN] a Glass Lner £ Brass Tube C Leachala H BlanklSpike 2 48 Hour <br /> C Plashc 500 ml F Olher D Hinseale I Other 3 24 Hour <br /> RECORDER (SIGN) D Plastic Ltlar E SoillSediment 4 Other <br /> NiJMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS v <br /> AND <br /> �--ii-- PRESERVATION $ m <br /> 88 x t g� sir SAMPLE <br /> 2 8a o av s'= g-� `aO ar? NOTES ASSIGNED CONDITION <br /> a� _ ¢� v° BOTTLE UPON <br /> DATE TIME SAMPLE ID I it = LL a z NUMBERS RECEIPT NOTES <br /> I M�� 3 1 ✓ <br /> 12 low A 3 I ✓ M&fu <br /> J l <br /> i <br /> NOTES 1 MISCELLANEOUS LReil qufsh by_Signature) R ved By (Signature) Date Time <br /> l)Pn� la <br /> L-AIL,; A d 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-A Chain (by Serial No) <br /> E Q-- Coo to e. N1 A,; <br /> Send Lab Results to (Name) --156104e (Check Office Below) Verbais Requested Yes 1-1No <br /> ❑ ATLANTA El DENVER ❑ IRVINE El MT VIEW ❑ PORTER OTHER M4DEST7] <br /> TEL(404) 9510055 TEL(303) 790-1747 TEL(714) 757 1755 TEL (415)960 1640 TEL(219)926 8651 TEL 249-579-j 2.1 <br /> FAX (404)956 9364 FAX (303) 799 0186 FAX (714) 757 0960 FAX (415)960 0739 FAX (219)926 7169 FAX ZBq 57912Z 5 <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 1303) 290-8336 • FAX (303) 290 8013 <br /> SERIAL NO 1 A r, ') I) WHITE Field Copy YELLOW Project copy PINK Laboratory Copy REV 8192 <br />