Laserfiche WebLink
`�7123F1� <br /> �- ENVIRONMENTAL (WIN-OF-CUSTODY RECORD PROJEi:T <br /> 1 i�v ' ' ' (See Reverse for Instructions) NO <br /> PROJECT NAME + rILTY SAMPLERS AUX SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES M <br /> 7 5 pa�4 (P'R`IM?) DESCRIPTION CODES A Ground water F Oil <br /> PROJECT NUMBER r �'�'�f�-+ A 40-ml VOA Vial B Surface Water G Waste 1 Standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H BlarnklSpiko 2 48 Hour <br /> RECORDER C Pfastic 500-ml F Other D Rinseate I Other 3 24 Hour <br /> (SIGN) D Plastrc Liter E Sod/Sediment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS o <br /> c AND g € e <br /> m t?m PRESERVATION g mm 10Y <br /> R <br /> �ME I cctd g�mY <br /> g $ o :22k Y� a �= E m"a� NOTES ASSIGNED COND TION <br /> E a LL � rm � � W ° BOTTLE UPON <br /> DATE TIME SAMPLE ID +fav LAD a _ N NUMBERS RECEIPT NOTES <br /> zq I I r V <br /> L <br /> 1 V <br /> s ti L) -VZ 4tV <br /> NOTES 1 MISCELLANEOUS Rellnqulshee y(Signature) Received By Ignature) D to Time <br /> NM Amtq e, of (Y1Tg VA kA ?d� cl <br /> A tV kow" �CC.'t�0I1 L �" iIn uls� wC� y <br /> 4 ml! , I q y (Signature} ecelved By (SIg ire) Date Time <br /> L z <br /> 607"607" 7 ODy,B � <br />� <br /> Relinquished B Ignature) ecelved By (Si atur ) at TI e Plzlcl; C voT1` <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 /> Send Lab Results to (Name) (Check Office Below) Verbals Requested Yes n❑ No 110 ATLANTA El DENVER ❑ IRVINE ❑ MT VIEW Elj�'`PORTER OTHER a b e-S TQ <br /> TEL(404)9510055 TEL(303) 790-1747 TEL(714) 757-1755 TEL(415) 960-1640 TEL(219) 926-8651 TEL2D9-r7a_zz <br /> FAX(404)956-9364 FAX (303) 799-0186 FAX (714) 757-0960 FAX(415) 960 0739 FAX(219)926 7169 <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)241-0488 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 147 '-4 A WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV 8192 <br />