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I <br /> { <br /> CANONIE EN1 IRONMENTAL. CHAIN-CSF-CUSTODY RECORD r+d PROJECT <br /> (See Reverse for Instriictlans) NC <br /> PRwECT NmE GQ SAMPLERS SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> 1 DESCRIPTION CODES A.a.onu werer F.on <br /> PROJECT NUMBER A.404M VIDA Vid a-suAaoew,t. a,wase r- <br /> ' 81 I B.mase LNw E.Or*"Tube C.Larfilde H.a wwspkii 2. Naw <br /> C.Pteena SWN F.Other o-at rae. t.0&W 3,24� <br /> RECORDER <br /> . ( 1 M Il-tic E.SatVSWb.nnt �.Other <br /> 6NUIMER ANALY REQUESTED LABORRATORY USE ONLYI f - 1 - SAMPLE <br /> NOTES ASSIGNED CONDITION <br /> BOTTLE UPON <br /> ATE TIME SAMPLE 1DETI NUMBERS RECEIPT NOTES <br /> a 5- DO oL� <br /> 13i ® S --T92-C- <br /> 35-TP - 1c1 �X <br /> 15r 00 <br /> 1 '" 0 2 - t <br /> of <br /> 4• o --r7 _tip <br /> Pu.� - r r x <br /> to S- -4. <br /> * _ f2 !! <br /> W 01 !! <br /> of 9 <br /> NOTES/MISCELLANEOUS Mis <br /> :(Signature) Received By:(Signature) Date Time <br /> :(Signature) Received By:(Signature) Data Ti <br /> L-�c.�T17 1 <br /> Relinquished By:(Signature) Received By:(Signature) tD <br /> Method of Shlpment Description of Other Ch alns-0!•Custvdy DISPatched By:(Signature) Date Time Received for lab By:(Signature) <br /> Transport Container Trensported with this TIrT�"p C,47 Chain(bY Ssrial IVo.I <br /> Send Lab Results to(Name): 4hM (Check Office Below) Verbals Requested:Yes El No ❑ <br /> ❑ PORTER PLEASANTON ❑ IRVINE ❑ ATLANTA ❑ OTHER <br /> TEL(219)926-8651 TEL(415)463.9117 TEL(714)757-1755 TEL(464)951-0055 TEL <br /> FAX(219)926-7169 FAX(415)463-2981 FAX(714)75740966 FAX(404)951.9364 FAX <br /> ❑ DENVER ❑ KING OF PRUSSIA ❑ HOUSTON ❑ MT.VIEW ❑ OTHER <br /> TEL(303)790.1747 TEL(215)337-2551 TEL(713)SWIS66 TEL(415)9W16W TEL <br /> FAX lam)799-0186 FAX(215)337-0560 FAX(713)55SM66 FAX(415)960-IrM FAX <br /> CANONIE ENVIRONMENTAL SERVICES CORP.•SOD CANONIE DRIVE-PORTER,1N 46304-TELEPHONE(219)926-8651 •FAX(219)926.7169 <br /> SERIa FIO wNRE:Field Copy YELLOW:P-t-1 CWY PINK L�b..ft"C�ft <br /> 1.?253 <br />