Laserfiche WebLink
CANONIE ENVIRONMENTAL C IN-OF-CUSTODY RECORD *ROJFC! <br /> (Seee Reverse for Instructions) NO <br /> Af 601 VL �Ra(t_� SAMPLERS LEX ' `Qp c y SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> PROJECT NAME DESCRIPTION CODES A Ground Water F Od <br /> �,� � 0(301 C'J A 40 ml VOA Vial B Surface Water G Waste 1 Standard <br /> PROJECT NUMBER B Glass Liter E Brass Tube C Leachate H BMank/Sprke 2 48 Hour <br /> (SIGN) C Plastic 500 ml F Other D Rmseate I Other 3 24 Hour <br /> 4 <br /> RECORDER D Plastic Liter E SO+IlSedlment 4 Other <br /> (SIGN) <br /> • NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS u <br /> AND It <br /> $_ a <br /> —R— PRESERVATION � <br /> ` x g$ a gx SAMPLE <br /> ti X "a NOTES ASSIGNED CONDITION <br /> �€ _ — v° BOTTLE UPON <br /> DATE TIME SAMPLE ID 2 NUMBERS RECEIPT NOTES <br /> 1$t )f) U �,'1 - aft <br /> 1 r,� V (l <br /> I �1� �_ A � j ✓ <br /> 1l fI 45 <br /> � 1 ,� A <br /> t�8ip OW r1L A n <br /> 11 Jr� fi <br /> Y Cy <br /> N <br /> I <br /> NOTES I MISCELLANEOUS y -• r r,� w ��1+fi r (s j�lz Relinquished by (Signature) R teived By (Stggature) Date Time <br /> �C f,�l t w.lt r >rG` rift ''/�-rid //:I0 <br /> u Pty�1 �t-' f�t� k \ tt {� Relinquished By (Signature) Received By (Signature) Date Time <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> Method of Shi rnent Description of Other Chains Of GustDispatched By <br /> Transport Container Transported with this �y �oqlqq;l <br /> (Sign`a[tDate Tlme Received for lab By (Signature) Date Tlme <br /> 610 Chain(b serial NO) <br /> Send Lab Results to (Name) (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)757-1755 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 El KING OF PRUSSIA ElPLEASANTON El PORTLAND El OTHER <br /> TEL(406)586-9496 TEL(713)556-1666 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 WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV 8192 <br />