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j tr f�VIV c fCf w ttriV�v rlltl�ialL IH ��-�1t"-a.i�, � vIU Y rrlCt��U n��� <br /> y (See Reverse for instructions) NO: 1 <br /> PROJECT NAME C1 Ut SAMPLERS�Lf I,?.w+� fr�CU SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> DESCRIPTION CODES A. Ground water F. oil <br /> PROJECT NUMBER z -a _ _ lA A. 40-ml VOA vial B. Surface water G, waste 1. Slandard <br /> - (SIGN) B. Glass Liter E. Bross Tube C- Leachate H. BlanklS Ilk 2. 48 Hour <br /> RECORDER r C. Plastic 500-m1 F,Other �r D. Smseate 1. Other 1 3- 24 Hour <br /> (SIGN) D. Plastic Liter E. Soil/Sediment -" 4. Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> i AND <br /> PRESERVATION ,0SAMPLE <br /> >s 0 aF "iV NOTES ASSIGNED CONDITION <br /> BOTTLE UPON <br /> DATE TIME SAMPLEID Vj I R P NUMBERS RECEIPT NOTES <br /> k X: K <br /> NOTES/MISCELLANEOUS j linqui had by: Signature) Received By: (Signature) Date Time <br /> Aft- s —7Z �j uv f1.1 1 TI- 1 A L f� p (� Relinquished By: (Signature) Received By: (Signature) Date Time <br /> �to►/" !�u Y� / f rvUe /lam!1 D Relinquished By: (Signature) Received By: (Signature) Date Time <br /> Method of Shipment Description of Other Chains-Of-Custody Dispatched By: (Signature) Date Time eceiv fo Ig ature) Date Time <br /> F' �} Transport Container Transported with this <br /> C RK 1, 3 Chain (by Serial No.) <br /> 3 vl �� <br /> Send Lab Results to (Name): - w KWNIK (Check Office Below) Verbals Requested: Yes ❑ No 9 <br /> ❑ ATLANTA 1:3 DENVER ❑ IRVINE ❑ MT. VIEW ❑ PORTER LTJ OTHEAEV2-2'/TEL(404) 951.0055 TEL(303)790-1747 TEL(714)757-1755 TEL(415)960-1640 TEL(219) 926-8651 T <br /> FAX(404)956.9364 FAX(303) 799-0186 FAX (714)757.0960 FAX (415)960-0739 FAX(219)926-7169 FZ5 <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER <br /> TEL(406)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 /> CANONIE ENVIRONMENTAL SERVICES, CORP. • 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 • TELEPHONE 303 290-8336 • FAX 303) 290-8013 <br /> SERIAL NO r' �' �� WHITE:field Copy YELLOW:Project Copy PINK:Laboratory Copy REV 692 <br />