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v.-.�.v�rs�. >I��r r rtrti sysr�rrlLrr� rl h�-IPAw4-yr-1oU7 fi VU v f' m.,umu rrtn��t�l <br /> (See ReverseTar Instructions) <br /> N� <br /> PROJECT NAME A lAN�V�S ��lZy1C.� SAMPLERS ALEX IrI0 5 SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> P INT) DESCRIPTION CODES A Ground Wale( F oil <br /> PROJECT NUMBER 4 '.3 0�~� A 415-ml VOA Vial a surlace waler n waste l standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate h alank/Spike 2 48 Hour <br /> RECORDER C Plastic 500 ml F Other D Rinseale I 011ier_ 3 24 Hour <br /> (SIGN) O Plastic Liter E SailSedimant 4 ORirr <br /> NUMBER Oh ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND � <br /> ^ — <br /> PRESERVATIONLr <br /> SAMPLE <br /> ^ <br /> H <br /> a ` e NOTES ASSIGNED COND TION <br /> fill <br /> DATE TIMEo BOTTLE UPON <br /> SAMPLE ID <br /> 3 = NUMBERS RECEIPT NOTES <br /> 09v �Ys <br /> 7101fooTu;- ;M — ——— —_ ✓ 7 <br /> r <br /> HIE I I M— —1 I I F—r I <br /> NOTES/MISRelinquished by (Signature) Ree ved By (Signature) D to TIm e� <br /> R' <br /> CELLANE 1 <br /> A1- <br /> � �I] 1 , r I Relinquished By (Signature) Received By (Signature) Date Time <br /> 7 (f <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> k i , <br /> Method of Shipment Description at Other Chains Of Custody Dispatched By (Signature) Date Time Received lot lab By (Signature) Dale Time <br /> Transport Container Transported with this <br /> Chpin(by Serial No) <br /> Q400(t-t E. COOL��. N7�tj <br /> Send Lab Results to (Name)- (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE' ❑ MT VIEW ❑ PORTED LI OTHER A40 OE57-0 <br /> TEL(404) 951-0055 TEL(303)790-1747 TEL(7141757-1755 TEL(415) 960-1640 TEL(219)926 8651 TEL 2r <br /> FAX(404) 9W9364rI---sl FAX(303) 799-0186 FAX(711 7570960 FAX(415) 960-0739 FAX (219) 926 7169 FAX 2�' - 1 R� <br /> ❑ BOZEMAN f_I HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER <br /> TEL(406)586-9496 TEL(713) 558-1688 TEL(215) 337-2551 TEL(510) 463 9117 TEL(503) 2410282 TEL <br /> FAX(406) 586-9724 FAX (713)556-0666 FAX (2 T) <br /> 3370560 <br /> FAX (510) 463 2981 FAX(503) 2410486 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP • 6300 SOUTH—SYNACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 • TELEPHONE 303 290-8336 a FAX (303) 290-8013 <br /> SERIAL NO I� r' ;; � WHITE Field Copy YELLOW Pra(ucl Copy PINI( Iahoialory Copy REV 819� <br />