Laserfiche WebLink
CANONIE ENVIRONMENTAL&AIWOF�CUSTODY RECORD 18B PROJECT <br /> (See Reverse for Instructions) NO. <br /> `an hl t a- t, Rt a +,tom 1 r , � LC.ti 'S` <br /> PROJECT NAME �� �� �� ' �,� $�MPLERS �MV SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> 1} L5 �N {PRI DESCRIPTION CODES A around Water F oil S <br /> PROJI=CT NUMBER 3 1 -k'-'�- A 40 m1 VOA Vlat a Surlac•water a waste t Standard „ r <br /> r) �� I 1� C? a (SIGN) r B Glass Liter E Brass Tube' C Leachate H SlanIUSplke 2 48 Hour <br /> ` RIwCORDER ' v r It _ 'I C Plastic 5u0-ml F Other D Rinseate I Other 3 24 Hour <br /> D Plastic Liter E SolllSedlmeni 4 Other. <br /> �„ { <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY ' <br /> t { L, CONTAINERS + <br /> AND <br /> r:j PRESERVATION <br /> r ) s iu r I r ¢a xP SAMPLE <br /> NOTES ASSIGNED CONDITION <br /> BOTTLE UPON r <br /> DATE TIME t's SAMPLE ID ? NUMBERS RECEIPT NOTES <br /> ow�z t' mr <br /> A Ak ' ,1vTS ✓ <br /> r r ✓ ' V11/1 <br /> s, r �� t, F , <br /> aa �r i Ir. <br /> �}(j I J J , I `' IN t", rl� ,� ''r' n, '_ � r{i�' -4- <br /> 00296 <br /> F 'S'r r <br /> I2 3 of 7 y d I+ ,y; , I <br /> 1 3 3 r 10 7 ,` . := r, s 1/ 3 <br /> v ✓ F ,, <br /> r tw ` <br /> rq r <br /> , <br /> t i r <br /> , <br /> d <br /> NOTES I MISCELLANEOUS } " ' r �r`l Relinquished by (Signature)c Re eived By ($+gnat`re) ate Time <br /> )Lr+Vi'z �� f _ rr S ! '' �� p3 1r� ` ;'�V V� ' U�cti.r—�_ � t I � i'L � r• V <br /> !. w N1PEt' a4c Relinquished By ( Ignature) ' , Received By (Signature) Date Time <br /> 'n '` iu ' 7 j, r , Relinquished By (Signature)�,' _ Received By (Signature) Date Time <br /> Method of Shipment c Description of Other Chains-Qf Custody Dispatched By (Signature) Date Time Received for lab By (Signature) Date Time <br /> Transport Container Transported with this <br /> r r�N'CoU .fE -} Choin (by Serial No) ' <br /> to 4l 11 <br /> t <br /> 6, i �.00JI � 1,4 �, { I) 0 96 /S <br /> Send Lab Results to (Name) 4-0�NAli ~`H 4AL WA (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ ATLANTA i i ❑ bENVER ur il �� � IRVINE ❑ MT VIEW 0,7 PORTER OTHER <br /> TEL(404)951-0055` TEL(303)79017471 TEL(714),757-1755 TEL(415)960.1840 7iiEL(219)926 8851 TELA <br /> FAX(404)956.9384' " ,s FAX,(303)799.0181, t L ,FAX;(714)757-0960 FAX(415)960-0739 I FAX(219)$26-7169 FAX x25' <br /> l 3 z ' 3� ! <br /> ❑ BOZEMAN sa� � ❑ Ii01�5TON� ,u �� 4� rn EKING OF PRUSSIA ❑ PLEASANTON 4 PORTLAND 1 I ❑ OTf fER I 1 <br /> TEL''(406)588-9496 ', TEL 713)556.1848] a!=t F r; 311 1-;(215)337-2551 TEL(510)463.9(17 ;1 {y {;TEL(t03)2410282 TEL <br /> FAX(406) 88-9724 ,i ir+FAX 713)558,gQQ �,, i 3-2981 Y r ,gfAX'(503)241-0486 <br /> FAX <br /> 'FAX'(215)337-0560 FAX(510)46 <br /> CANONIE ENVIRONMENTAL SERVICES, CORP • 8300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 • TELEPHONE 303 290-8338 • FAX 303 290-8013 <br /> SERIAL NO 15,671 <br /> 671 WHITE Field Copy YELLOW ProOd Copy PINK Laboratory Copy REV M2 <br />