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'40M <br /> MCA%Nff4---Nfflh01NE9A1R%- F-!MS-ffl%Y%Cft M M#RO MP <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME -MV]Sb SAMPLERS ALEx T:j-oe s SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> ,` �7 /� (PRiN DESCRIPTION CODES A Ground Water F Oa <br /> PROJECT NUMBER i <br /> 9` '�3 f 01—�S,, �/lR�![� i Q� A 40-ml VOA Vial B Surface Water G Waste t Standard <br /> (SIGN) B Glasa Luer E Brass Tube C Leachate H Blank/Spike 2 48 Hour <br /> RECORDER C Plastic 5(0. <br /> ] ml F Other D Rmseate I Other 3 24 Hour <br /> {SIGN) D Piasbc Liter E Sou/Sediment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND <br /> PRESERVATION ^ a� " <br /> S € s SAMPLE <br /> $ $ s _ i NOTES ASSIGNED CONDITION <br /> DATE TIME SAMPLE ID � v , ' m BOTTLE UPON <br /> NUMBERS RECEIPT NOTES <br /> 32 0 v I I I t 14 DAY-t, ✓ <br /> IV <br /> NOTES I MISCELLANEOUS �+ILVVIPL>✓ Re nquiSW <br /> y (Signature) Re eived By (Signature) Date Time <br /> Pt!EASe 06-rc- <br /> LAd, P,C, I+J Te-�P Q-Ar-o Rte,. oPorj T ML e oz -v yL 3; 6 <br /> A Relinquished By (Signature) Received By ('Signature) Date Time <br /> A-eAI V A L <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) <br /> A(2ko"- Ceu iztEe- C oot-j5►- of A <br /> Send Lab Results to (Name) ::E 11A W TT-E 9M A til (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER OTHER <br /> TEL(404)951-0055 TEL(303) 790-1747 TEL(714)7571755 TEL(415)960-1640 TEL(219)926-8651 TEL <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 <br /> TEL(406)586-9496 TEL(713)556-1686 TEL(215)337-2551 TEL(510)463.9117 TEL(503)2410282 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 15644 <br /> 5 ^ ` 4 WHITE Field Copy Project Copy PINK Laboratory Copy REV B/92 <br />