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CRROM EIMR6% AATOh�UMDftE�D" R <br /> y (See Reverse or Instructions) N <br /> PROJECT NAME n� SAMPLERS Tl t F ` 1 0+l SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> DESCRIPTION CODES A Ground Water F oil <br /> PROJECT NUMBER `�� 4 t" /�Y�fZ41-Q A 40 ml VOA Vial a Surface Water G Waste 1 Standard <br /> (SIGN) a Glass Liter E Brass Tube C Leachate H Blank/Spike 2 48 Hour <br /> RECORDER C Plastic 500-ml F Other D Rlnseale I Other 3 24 Hoer <br /> (SIGN) D Plastic Liter _ E SoillSedlmenl _ 4 Olher <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS Lar <br /> `o AND 4- <br /> §p PRESERVATION $Y 8 $ -4 <br /> iS tf $ <br /> '` ¢� E= nu 4u NOTES ASSIGNED CONDITION <br /> SAMPLE <br /> E' LL'kk'�' `� �@ °V BOTTLE UPON <br /> DATE TIME SAMPLE ID �� Ll �� in = NUMBERS RECEIPT NOTES <br /> rr�v� <br /> eLH3Y'� tLTij V,I 2- 013 v ✓ !� i I �. ✓ a, —.,���P T y� <br /> Vj <br /> Ya y— <br /> NOTES 1 MISCELLANEOUSRetlnqul hod by (Signature) Reapwed By (Signature) Date Time <br /> E AS E VE7 L 0(z la S A vilk V t t~ , j� <br /> 7� t V- I'y (�—'� 1 ,{ .I r�. i�"&a <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 /> Chain (by Serial No} - <br /> (�U1'1 e"',, n�. r,1{lQ-, I`l `, <br /> Send Lab Results to (Name) 1.1t l t - r A , + (/Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER BOTHER <br /> TEL (404) 951 0055 TEL(303) 790 1747 TEL (714) 757 1755 1 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`,t I`t <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER <br /> Ift(446) 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 /> URIAI fin WIIITF ri"Id(`oliv )rl I OW Pwim I('nrn I'Ril( I I.a nn (, nr" i1,1`^ <br />