Laserfiche WebLink
CANONIE ENVIRONMENTAL MAIN-OF-CUSTODY RECORD & PROJECT <br /> c� F� (Se Reverse for Instructions) NO <br /> PROJECT NAME { )r°t�r iy SAMPLERS-&tt-UV "'"� ( "" SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> ! (PRIryrJ ` h r DESCRIPTION CODES A Ground Water F OI <br /> PROJECT NUMBER 1 1 14p"V �fh !} ` A 40 ml VOA vial B Surface Water G Waste 1 Standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H BlaO/Spike 2 48 Hour <br /> RECORDER C Plastic 500 ml F Other D Rlnseate I Other 3 24 Hour <br /> (SIGN) D Plastic Liter E SO4ISedlmenl 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS u <br /> c AND g a m <br /> 5°^m nm PRESERVATION b <br /> Lfl <br /> �g a` S ;I a _% SAMPLE: <br /> Sm z .� t ) m°<� NOTES ASSIGNED CONDITION <br /> E° - g x �- E ov BOTTLE UPON <br /> DATE TIME SAMPLE ID _ { N z NUMBERS RECEIPT NOTES <br /> 41477-i icly cr--f 115. <br /> tC15 &-- 0 <br /> It�7 Cr- �f <br /> 110 Cr--31 <br /> i1E`[ L <br /> 1l Lu G <br /> It;Ij - 3' .41 <br /> A Ly <br /> NOTES I MISCELLANEOUS Rellnwished by (�4gnature) Re eyed By (Signature) Date Time <br /> 11-CVr _ ts�p <br /> 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 /> y�rG'1 Chain (by Serial No) <br /> Ce'< LL'r <br /> Send Lab Results to (Name) (Check Office Below) Verbals Requested Yes ❑ No -k? <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER I OTHER � -.QJ0 <br /> TEL (404) 951 0055 TEL(303) 7901747 TEL(714) 757-1755 TEL (415) 9601640 TEL (219) 9268651 TEL VaI SM'i-2LI <br /> FAX (404) 956 9364 FAX (303) 799 0186 FAX (714) 757 0960 FAX (415) 960 0739 FAX (219)926 7169 FAX IjIl <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER <br /> TEL (406) 586 9496 TEL (713) 5561666 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) 2410486 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORE• 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 • TELEPHONE (303) 290 8336 • FAX (303) 290 8013 <br /> SERIAL NO /i (i i I (` WHITE Field Copy YELLOW Pro(ecl Copy PINK Laboratory Copy REV 8792 <br />