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G79::vi4es . ENKV411R;®ENIVIILNTAL CHAfN�OfF CEJ I ODY R� - ,T <br /> r <br /> ` (See Reverse for Instructions) NO. <br /> PROJECT NAME SAMPLERS �-' r'IQ��S SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> NN.. PROJECT NUMBER (PRINT) ; DESCRIPTION CODES A. Ground Water F. Oif <br /> - ..// n /� A. 4Pml VOA Vial <br /> -,/',�.Lr/l—,- �"' B. Surface Wafer G. Waste 1. Standard <br /> {SIGN) B. Glass Liter E. Brass Tube C- Leachate H. BlankQSf Ike 2. 48 Hour <br /> RECORDER C. Plastic 500-ml F.Other 0. Rinseate I. Other_ _ 24 Hour <br /> (SIGN) D. Plastic Liter w E. Soil/Sediment - Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS e <br /> g AND <br /> PRESERVATION LLQ$ma E¢g w an <br /> o-�- <br /> SAMPLEY <br /> 8^ " F max <br /> i ¢m NOTES ASSIGNED CONDITION <br /> ¢ 2 BOTTLE UPON <br /> is ozDATE TIME SAMPLE ID a <br /> NUMBERS RECEIPT NOTES <br /> �} <br /> 4:F <br /> NOTES!MISCELLANEOUS Relinquished by: (Signature) Received By: (Signature) Date the <br /> Relinquished By: (Signature) Received By: (Signature) Date Tune <br /> i <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 Serial No.) �_ 032698 <br /> t�rLt E A &V, t � <br /> Send Lab Results to (Name): (Check Office Below) Verbals Requested: Yes ❑ No ❑ <br /> I <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT. VIEW ❑ PORTER Iyer OTHER ' <br /> TEL(404)951.0055 TEL (303) 790-1747 TEL(714) 757-1755 TEL (415) 960-1640 TEL(219) 926-8651 TEL J <br /> FAX(404)956-9364 FAX (303) 799-0186 FAX (714) 757.0960 FAX (415) 960-0739 FAX (219) 926-7169 FAX <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER L <br /> TEL <br /> 66).586-9496 TEL(713) 556-1666 TEL(215)337.2551 TEL(510) 463-9117 TEL (503) 241-0282 TEL <br /> FAX(406) 586-9724 FAX(713) 556-0666 FAX (215) 337.0560 FAX (510)463-2981 FAX (503) 241-0486 FAX <br /> CANQNIE'ENVIRONMENTAL SERVICES, CORP. • 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 • TELEPHONE (303) 290-8336 • FAX (303) 290-8013 <br /> SERIAL NO. _ 1 1- r n P1 WHITE-Fiell Com VFt I rrw Prnfnrt r,. ❑Irv.i --- <br />