Laserfiche WebLink
• CANONIE ENVIRONMENTAL *AIN-OF-CUSTODY RECORD PROJECT <br /> !! (See Reverse for Instructions) <br /> PROJECT NAME f TO `I� ; t t ��r u4\- SAMPLERS f�+ QV^� V�0 SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PRItNP ft� DESCRIPTIONCODES A Ground Water F Oil <br /> PROJECT NUMBER * %y�� r �� � V�" ` A 40 ml VoA Vial B Surraca Water G Waste 1 Standard <br /> (SIGN) B Glass Later E Brass Tube C Leachate H BtanklSpike 2 48 Hour <br /> RECORDER —121 t 1-J C Plastic 500 ml F Other— D Hinseate I Other 3 24 Hour <br /> (SIGN) D Plastic Liter __—_— E SodlSediment 4 Other_ <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> m o AND o c $ d w <br /> m 4 PRESERVATION $ a <br /> mY mS =hSAMPLE <br /> o m o" nu` r NOTES ASSIGNED CONDITION <br /> a. C2 R— A S Y-y 9 <br /> E° i t ` ° BOTTLE UPON <br /> DATE TIME SAMPLE ID A � � � {7 N NUMBERS RECEIPT NOTES <br /> it iii{1 r -.31 <br /> T -rI(fr <br /> IZI f f. ( - �, ,r t 1 i <br /> IIt�`t f< ) 0 {� <br /> Lt D -- <br /> ' — <br /> I ] <br /> NOTES!MISCELLANEOUS Rellnq (shed by{)($ignature) Received By (Signature) Date Time <br /> Relinquished By (Signature) RPceired By (Signature) r 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 [[its Chain (bySerialNor)ft <br /> C•1�t �`f f <br /> 1111,44".1 r V rr t" 1`((f Ms _ <br /> Send Lab Results to (Name) r ,�Y, t 1�!v1° , -- (Che(,k Office Below) Verbals Requested Yes ❑ No Cl <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW U PORTER OTHER 110111L1 <br /> TEL (404) 9510055 TEL (303) 790 1747 TEL (714) 757 1755 TEL (415) 960 1640 TEL(219)926 8651 TEL ].ri f i M <br /> FAX (404)956 9364 FAX (303) 799 0186 FAX (714) 757 0960 FAX (415)960 0739 FAX (219) 926 7169 FAX 701 1 r1 t`7 L'� <br /> I <br /> ❑ BOZEMA14 ❑ 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) 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, CORP • 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 • TELEPHONE 1303) 290-8336 • FAX (303) 290 8013 <br /> SERIAL NO 7 �. WHITE Field Copy YELLOW Protect Copy PINK Laboratory Copy REV 8192 <br /> I 1 <br />