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IN Re forq uct" <br /> PROJECT NAME SAMPLERS SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> PROJECT NArME <br /> PRINT) [A. <br /> ESCRIPTION CODES A Ground waler F on <br /> PROJECT NUMBER ('I 1 W14C-2 aml VOA Vial a Surface water a waste i Slandard <br /> (SIGN) ass Liter E erase Tubs C Leachate H BlanklS Ike 2 48 Hour <br /> RECORDER astic 500•ml F OtherI_�� D Rtnseata I Other 3 24 Hour <br /> {SIQN} astic Liter E 3oIIISedlment 4 Olher <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS y <br /> AND <br /> PAESERVAMN ` <br /> 1E^ <br /> IV <br /> X I SAMPLE <br /> NOTES ASSIGNED CONDITION <br /> - - IV BOTTLE UPON <br /> DATE TIME SAMPLE ID NUMBERS RECEIPT NOTES <br /> �1 02 NL _ '" C3( <br /> ro I +� CO- <br /> 11 T <br /> v <br /> NOTES t MISCELLANEOUS Relinquished b (Signature) alva i nature D e Tlme <br /> Ste/ 1/�1�G 4 Y ( 9 ) Y 9 <br /> LA$. fit! nrT! ,� a I 5 <br /> LcC�I�C�J/� tC <br /> 7-2//&1-5 1. ,,,FjQllnqul ed By (Signature) a eived By (SI tura} Dae Time <br /> G J VRe�liinnqulshe y (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 /> TP-4me, (rOUw-t e p, Chain(by Serial No) O <br /> to tZ X_ �rzv9 <br /> Send Lab Results to (Name)- A5_ (Check Office Belo Verbal Requested Yes ❑ No ❑ <br /> ❑ DALLAS ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER " OTHARt �T� <br /> LR <br /> TEL(214)770-1800 TEL(303)790.1747 TEL(714)7571755 TEL(415)960-1640 TEL(219) 926 8651 TEL2 <br /> FAX (214) 770-0249 FAX(303)799-0186 FAX(714)757-0960 FAX(415)960-0739 FAX(219)926-7169 FAX L <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER r <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)531-8888 FAX (215)337-0560 FAX(510)463 2981 FAX(503)241-0486 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP a TWO GALLERIA TOWER a 13455 NOEL ROAD, SUITE 1500 • DALLAS, TX 75240 • TELEPHONE 214 7701800 • FAX(2114)770-0249 <br /> SERIAL NO 21159 WHITE Field Copy YELLOW Project Copy PINK Leborelary Capt' REV 11193 <br />