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CANUN1E ENIMUNIVIEN I AL CHAIN-U1=-CUS'I UUY HECOHD LAB PHUJECt <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME ; l� �)r ' SAMPLERS ' / t- , I SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> J r , (PRINT) DESCRIPTION CODES A Ground Water F oil <br /> PROJECT NUMBER Li �" �� �� �l �'S ( ���I s° t A 40 ml VOA Vial B Surface Water G Waste 1 Standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H BlanklSpike 2 48 Hour <br /> C Plastic 500 ml F Other D Rmseale I Other 3 24 Hour <br /> RECORDER (SIGN) D P'asl+c Luer _ E SoillSed}ment — �— 4 Other---- <br /> NUMBER OF ANALYSIS REOUESTED LABORATORY USE ONLY <br /> CONTAINERS ' o <br /> c `o AND <br /> -n'm nv PRESERVATIONo o <br /> m f cy n_ <br /> I SAMPLE <br /> �g <br /> a Emr< gm m <br /> �g °$7,5nu , d Em-o" NOTES ASSIGNED CONDITION <br /> rEma t� � � � � BOTTLE UPON <br /> DATE TIME SAMPLE !Dt, N x NUMBERS RECEIPT NOTES <br /> I dayk V Ilob <br /> �ol0oa <br /> G <br /> NOTES 1 MISCELLANEOUS r Relinquished-by (Signature) Received By (Signature) Date Time <br /> ( <br /> (; r f <br /> !Vpt�f Relinquished By (Signature) Received By (Signature) Date Time <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> Method of Shipment Description of Other Chains-Of Custody Dispatched By (Signature) Date Time Received for lab By (Signature) Date Time <br /> V /^? o/d Transport Container Transported with this <br /> Chain (by Serial No) <br /> C^C�t.a �- ( f V .�'Ao L r6- IL 1, {1; <br /> Send Lab Results to (Name) > �.-' )_r I (r V-114r4NI (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> / 1/0��rS7 L 1 <br /> ElATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW EJPORTER © OTHER <br /> TEL(404) 9510055 TEL(303) 790 1747 TEL(714) 757-1755 TEL(415)960-1640 TEL (219) 926 8651 TEL- ?'.) f <br /> FAX (404) 956 9364 FAX(303) 799 0186 FAX (714) 757 0960 FAX(415) 960-0739 FAX (219)926 7169 FAX WA -'/ _�' <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER <br /> TEL (406) 586-9496 TEL(713)556-1666 TEL(215) 337 2551 TEL (510) 463 9117 TEL(503)2410282 TEL <br /> it FAX (406) 586 9724 FAX (713) 556-066$ FAX (215) 337-0560 FAX (510) 463 2981 FAX (503) 2410486 FAX <br /> CANONIE FAWIRONMENTAL SERVICES, CORP • 6300 SOUTH SYRACUSE WAY, SljjjE 300 • ENGLEWOOD, CO 80111 • TELEPHONE k303) 290-8336 • F 303) 290-8013 <br /> WIAL NOi� WHITE Field Copy YELLO cl Copy PINK Laboratory Copy REV 8792 <br /> y Q <br /> I). 1 �_ <br />