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M Mom MCA%NWE1`iift0MEftL6hA . Sfft?ftC D M 0j" <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME �_t��G �TU(-y" SAMPLERS G ��" "1° ul SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> q PRI DESCRIPTION CODES A Ground Water F Oil s <br /> PROJECT NUMBER I q 115 r` A 40-ml VOA Vial B Surface water a waste 1 Standard A� <br /> (BIGN) 8 Glass Liter E Brass Tube C Leachate H BlanklSplke 2 48 Hour ` <br /> r <br /> RECORDER C Plastic WO-ml F ht�e - D Rinseate I Oth � 3 24 Hour <br /> (SIGN) O Plastic Liter a� E Sotl/Sedlment t 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS — �'7 <br /> J' <br /> PRESERVATIONAND //�_ x <br /> SAMPLE <br /> NOTES ASSIGNBOTTLED COUPONON <br /> ` <br /> DATE TIME SAMPLE ID g NUMBERS RECEIPT NOTES <br /> ox-)S load CoKL �-Fr--kit i ' l <br /> NOTES 1 MISCELLANEOUSelinquishd b�ure) Re Y, gnature) 2 Date Ttme <br /> 2 A <br /> � <br /> I hod By (Signature) Recetved fay (Slgnatu Date Time <br /> r <br /> e Inqul e y (Signature) Receive (Signature) Date Time <br /> Method of Shipment Descnptlon of Other Chains-Of-Custody Dispatched By (Signature) Date Time Received for lab By (Signature) Date Ti me <br /> 1 T nsport Container Transported with this <br /> r Chain (by Serial No) <br /> / f <br /> Send Lab Results to (Name) (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ DALLAS ❑ DENVER ❑ IRVINE ❑ MT VIEW ' ❑ PORTER OTHER E. &/U", <br /> TEL(214)770-1800 TEL(303)790-1747 TEL(714) 757-1755 TEL(415)960-1640 TEL(219)926 8651 TEL u! 53y, " <br /> FAX(214)770-0249 FAX(303) 799-0186 FAX(714) 757-0960 FAX(415)960-0739 FAX(219) 926-7169 FAX P07- 93,-, TO <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER <br /> TEL(406)586-9496 TEL(713)589-8686 TEL(215)337-2551 TEL(510)463-9117 TEL(503) 241-0282 TEL <br /> FAX (406)586-9724 FAX(713) 531-8886 FAX(215)337-0560 FAX(510)463.2981 FAX(503) 2410466 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP • TWO GALLERIA TOWER • 13455 NOEL ROAD, SUITE 1500 • DALLAS, TX 75240 • TELEPHONE (294) 7701800 • FAX(214) 770-0249 <br /> SERIAL NO f'�� +� Q' WHITE Field Copy YELLOW Prgect Copy PINK Laboratory Copy REV 11193 <br />