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r� I'FiVJti.l <br /> i (ANUNIE F-WHUNMEN-I AL 19A1N-OF-CU5_1 UUY HELUHU �� <br /> 20 <br /> See Reverse for Instructions NO* <br /> PROJECT NAME k1 �-� � ' ST -� SAMPLERS AI-Ey fie,to C S SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES- <br /> J (PAIN�i- DESCRIPTION CODES A Ground water F Oil y <br /> PROJECT NUMBER {-� - �� 7� �¢SL, f- �f1 Eye �J A 40-ml VOA Vial B Surface Water G waste 1 Standard <br /> (SIGN) a Glass Liter E Brass Tube C Leactiate H Blank/Spike 2 48 Hour <br /> RECORDER C Plastic 500-ml F Other D Rmseate I Other 3 24 Hour <br /> (SIGN) D Plastic later E SOdJSediment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS e <br /> Z <br /> ~� `s AND 'J'% 4,� <br /> u 9 PRESERVATION $^ 2:11C'gid <br /> to SAMPLE <br /> m°<5 NOTES ASSIGNED CONDITION <br /> E- 2 r �v �- �` BOTTLE UPON <br /> DATE TIME SAMPLE ID tf u) = NUMBERS RECEIPT NOTES <br /> N l 1 v�- _5 Myl V <br /> NOTES 1 MISCELL ANEOUS _ Relinquished by (Signature) Rjcewed By ( ! nature) Date Time <br /> 016 St.ovlolA Y"-4 C_ � P0 :)� <br /> Relinquished By (Signdture) Received By (Signature) t ` D to 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 /> Transport Container Transported with this <br /> Chain (by Serval No) 16 <br /> Send Lab Results to (Name) AIV/VE N_0141,6-Sf (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ DALLAS ❑ DENVER ❑ IRVINE 11 ❑ MT VIEW ❑ PORTER OTHER MAVE-TO <br /> TEL (214) 770 1800 TEL(303) 790-1747 TEL(714) 757 1755 TEL(415)960-1640 TEL(219)926-8651 TELT 74 Z-7-24 <br /> FAX (214) 770 0249 FAX(303) 799-0186 FAX (714) 757-0980 FAX(415)960 0739 FAX (219)926-7169 FAX _ - - � <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) 5318886 FAX (215) 337 0560 FAX(510)463-2981 FAX (503) 241-%486 FAX <br /> _CANONIE ENVIRONMENTAL SERVICES, CORP - TWO GALLERIA TOWER • 13455 NOEL ROAD, SUITE 1500 - DALLAS, TX 75240 - TELEPHONE (214) 770-1800 - FAX(214) 770-0249 <br /> SERIAL NO 21160 <br /> q1C0 WHITE Field Copy YELLOW Prosed Copy PINK Laboratory Copy REV 11193 <br />