Laserfiche WebLink
I;ANUNIC CIV V IMU141VIL14 I HL 1;11HII1j-OF-CU5I VUY HECrCURD LAB PROJECT <br /> (See Reverse for Instructions) NO <br />` PROJECT NAME - T-y SAMPLERS AL-EK tc 12c 5 SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PRINT) DESCRIPTION CODES A Ground Water F oil <br /> PROJECT NUMBER_ a 4 '3 Uo t LC -�� A 40-ml VOA Vial B Surlace water G Waste 1 Standard <br /> (SIGN) B Glass Liler E Brass Tube C Leachate H Blank/Spike 2 48 Hour <br /> RECORDER C Plastic 500 ml F Other D Rinseate I Other 3 24 Hour <br /> (SIGN) D Plashc Liter E SalUSediment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS 4 <br /> AND u f" a <br /> pm sm PRESERVATION $_ m� $ m b <br /> Y a SAMPLE <br /> �� as WI <br /> ¢— es )} NOTES ASSIGNED CONDITION <br /> �v ° BOTTLE UPON <br /> DATE TIME SAMPLE IDvV 5 Z NUMBERS RECEIPT NOTES <br /> rM00,116 )350 f"1 A 14&Y ✓ <br /> CWq(. ii}Z M -ZAIA 1 1 3 ✓ V v <br /> bl3 MW-3 ✓ <br /> o MW-Lf ✓ <br /> 1f <br /> 5 NAw-5 t ✓ v <br /> JqD0 MW-G A A 1 11I ✓ <br /> i <br /> I <br /> NOTES 1 MISCELLANEOUS C <br /> Er (ZeWeo r3�+ #k4j�pLrG Relinquished by (Signature) R Iver By (Signature) Date Time <br /> LAB" <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> u4(3 �R-RIVa�L , <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> Li <br /> Method of Shipment Description of Other Chains-Of-Custody Dispatched By (Signature) Date Time Received for lab By (Signature) Date Time <br /> Ap� r Transport Container Transported with this ) <br /> A9,Gr0 P Chain (by Serial No) � `00 /�;Sr <br /> W19AZ,1E12 Lwt--C Iz-- M ft 'A /.52s-- <br /> Send <br /> . 2Send Lab Results to (Name) '"V-M(-,I tj (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER OTHER W'IESTO 1 <br /> TEL(404)951-0055 TEL(303) 790-1747 TEL(714) 757 1755 TEL(415)960 1640 TEL (219) 926-8651 TELZDi:: ��J <br /> FAX (404)956-9364 FAX(303) 799.0186 FAX(714)757-0960 FAX(415) 960-0739 FAX (219) 926-7169 FAX <br /> f ❑ 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)241-0486 FAX <br /> ,CANONIE ENVIRONMENTAL SERVICES, CORP + 6300 SOUTH SYRACUSE WAY, SUITE 300 - ENGLEWOOD, CO 80111 + TELEPHONE '303 290-8336 + FAX 03) 290-8013 <br /> SERIAL NO WHITE Field Copy YELLOW Copy PINK Laboratory Copy REV 8192 <br /> 1 11177 <br />