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m" Mem AMNIMNWROWERMLOA11MMOS' CMDM M" OMP <br /> (See Reverse for Instructions) NO —5 � L <br /> PROJECT NAME ^ COLA ST0C.K7_p1I SAMPLERS p tZ x rLbleE S SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> p /(�PRIN�T) DESCRIPTION CODES A around water F CHI <br /> PROJECT NUMBER _. :_ IO � J 7�-1r(9•f�-j A 4pml VOA Vial B surface water 0 waste t standard <br /> (SIGN) B Glatt Liter E Braes tube C Leachate H BlankfSplke 2 sB Hour <br /> RECORDER c Ptaelic 600-mf F Other D Alnseels I other 3 24 Hour <br /> ISIGK! D Plastic Liter E Soil/Sediment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND <br /> PRESERVATION 4 ■ <br /> SAMPLE <br /> �>s NOTES ASSIGNED CONDITION <br /> — — BOTTLE UPON <br /> DATE TIME SAMPLE ID y NUMBERS RECEIPT NOTES <br /> r qe ,(_ Lj .14 1 A IV15 A A II l'I DNS 0" <br /> r 5 I ✓ ✓ 3 <br /> S #mw-4 A A If I ✓ <br /> 61 162D cs MW:5 ✓I IV < ✓ ✓ ( ✓ <br /> MW- 1/1 165d ) ✓ ✓ ✓ Co <br /> iYlf� _ 11. l <br /> NOTES t MISCELLANEOUS Relinquished by (Signature) Re d By Iur Date Time <br /> SEQuv(fl �+.I A�-yTi[a°I �. �(_d- -Q-t� (�� 1 �r t <br /> alinquished (51 ature) Recely i (Signature) Date Tlme <br /> Itngdished By (Signature) Received By (Signature) Date Time <br /> Methodor 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 /> Chain(by Serial NO) <br /> i ooL-cYL <br /> Send Lab Results to Name • E A N�t nn �{ f 7 <br /> ( (Check Office Bel Verbals Requested Yes ❑ No ❑ <br /> �,/ <br /> ❑ DALLAS El DENVER ❑ IRVINE 0' MT VIEW ❑ PORTER 1'J OTHEA 6SCA LO nI <br /> TEL(214) 770.1800 TEL(303) 790-1747 TEL(714)757-1755 TEL(415)960.1640 TEL(219)926-8651 TEL 3 <br /> FAX(214) 770-0249 FAX(303) 799 0186 FAX(714)757-0960 FAX(415)960-0739 FAX(219)926.7169 FAX 2697038�__93 <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ­4zAia, ❑ OTHER <br /> Yap TEL(406)58e-9496 TEL(713)589-8686 TEL(215)337-2551 TEL(510)463.9117 TEL(503)241-0282 '' - TEL <br /> OAX(406)586-9724 FAX(713)531-8886 FAX(215)337-0560 FAX(510)463-2981 FAX(503) 241-0,¢86 FAX <br /> y'ANONIE ENVIRONMENTAL SERVICES, CORP a TWO GALLERIA TOWER a 13455 NOEL ROAD, SUITE 1500 a DALLAS, TX 75240 a TELEPHONE (214) 7701800 a FAX 214 770 0249 <br /> SERfAL NO {� /1 WHITE Field Copy YELLOW Proled Copy PINK Laboratory Copy REV 11193 <br />