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B PROJECT <br /> (See RavefinNWOAM i0 nstructions) ' No <br /> PROJECT NAME C f4MPLERS SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> DESCRIPTION CODES X Groupe Wolof F at <br /> PROJECT NUMBER — A. 16{M VOA Vhf a surface Wolof G wool. t.neud <br /> {SIGPf! IL mass Lner E areasT+ C LeachateJe H Blank/Spike <br /> RECORDER Q Plastic 5W4W F Other /1 D �!":.," I re a 24 Hex <br /> (SIGM 0 Plastic Liter 1 E son/Se .nr 4 othor <br /> -- - <br /> NUMBER of ANALYSIS REQUESTED <br /> CONTAINERS <br /> LABORATORY USE ONLY <br /> rm <br /> AP <br /> ARESION <br /> EAVAT _ fall �— <br /> i <br /> 1 SAMPLE <br /> F NOTES ASSIGNED CONDITION <br /> DATE TIME SAMPLE ID BOTTLE UPON <br /> NUMBERS RECEIPT NOTES <br /> t <br /> 1: <br /> 4 <br /> OTES!MISCELWVEO 3 nq E e by ( gnature) Received By (Sig tuDate Tlm© <br /> _r ILA ra <br /> '16-Aelinqi Is ed By (Signature) R 1ved a!3 SI nature <br /> ( ) to Time <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> t Method o1 Shipment Desct1p11on of Other ChfalnS-01-Custody Dispatched By'(Signature) Date Time Received for lab By (Signature) Dale Time <br /> Transport Container Transported VdIh this <br /> ytbt(1t11J(d'l Chain(by Serle!No) <br /> KD t <br /> Send Lab Results to (Name)• IVAE (Check Office Below) Verbals Requested Yes No ❑ <br /> ❑ PORTER PLEASANMN n fRVINE <br /> ❑ ATLANTA <br /> TEL(218}92&8851 TEL(U6)483-9117 Q " ❑ OTHER _ <br /> FAX 219 928651 TEL(714)757.1765 " TEL(404)951-0055 TEL <br /> ( ) FAX(�15)463-2981 FAX(714)7bT-0980 <br /> A <br /> r FAX(404)951-8364 FAX <br /> ❑ DENVER + ❑ KIN#i 8F PRUSSIA ❑ HOUSTON ❑ MT VIEWTEL(303)-M(>1747 TEL(215)337-2551 TEL(713)658.1888 TEL(415)9601840 ❑ OTHER <br /> T ER <br /> FAX(303)799.0166 TEL <br /> FAX(215)337-0560 FAX(713)658.0688 FAX(415)960-0739 FAX <br /> CANONIE ENVIRONMENTAL SERVICES CORP • 800 CANONIE DRIVE • PORTER IN 46304 • TELEPHONE 219 926-8651 • FAX (219) 926-7169 <br /> BEAK Na n Q n ? Q WHITE FWId Covr YE+WWY-Poict OVy PINK.Lab-"� <br />