Laserfiche WebLink
CANONIE ENV IRON MENTAL&AIN-OF-CUSTODY RECORD PROJECT <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME IXA, SS SAMPLERS ALEx q o 0--C. 5 SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> �['y1� 44- :304 <br /> �h �( '-{PRI DESCRIPTION CODES A Ground water F Oil <br /> PROJECT NUMBER O 44- 3a 4 A J�1L+tL��� A 40-ml VOA Vial B Surface water G waste 1 Standard <br /> (SIGN) a Glass Liter E Brass Tube C Leachate H BlanVSpike 2 48 Hour <br /> RECORDER C Plastic 500,mi F Other D Rinseate I Other 3 24 Hour <br /> (SIGN) D Plastic Liter E SoilfSodiment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS u <br /> c.g <br /> nAND �^, g—g Pi4E5ERVAFION B ° � m <br /> SAMPLE <br /> o NOTES ASSIGNED CONDITION <br /> -it $fi eBOTTLE <br /> DATE TIME SAMPLE IDS z ~ zv UMBERS RECEIPT PT NOTES <br /> 6531 1355 1 <br /> 0530 J <br /> 5105 S -2- <br /> NOTES <br /> 2NOTES l MISCELLANEOUS , Relinquished by (Signature) Received By (Signature) Date Time <br /> LAB R�lo� Relinquished By (Signature) Received By (Signature) Date 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 Serial No) <br /> A o Go <br /> Send Lab Results to (Name) (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ DALLAS ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTEROTHER <br /> TEL(214) 770 1800 TEL(303) 7901747 TEL(714) 757-1755 TEL(415)960.1640 TEL(219)926 8651 TEL <br /> eq <br /> FAX (214)770-0249 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) 589 8686 TEL (215) 337 2551 TEL(510) 463-9117 TEL (503) 241-0282 TEL <br /> FAX (406) 586 9724 FAX (713) 531-8886 FAX(215) 337 0560 FAX(510) 463-2981 FAX (503) 241-0486 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 21193 <br /> 1193 WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV 11)93 <br />