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fi 'CA%NnN%OMEML UAI�F- bSIMY MCIrRD ' VPROJECT <br /> kk <br /> (SeeReverrse for Instructions) NO <br /> PROJECT NAME qq 319AMPL S d& A 4A SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> PROJECT NUMBER w `T `V r DESCRIPTION CODES A Ground water F oil <br /> ami VOA Vial a Surface Water G Waste 1 Standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H alanklSpike 2 48 Hour <br /> RECORDER C Plastic 500-mi F Other D Rrnseate I Other 3 24 Hour <br /> (SIGN) D Plastic Liter E SolllSediment 4 Other <br /> NUMBER OF ALY%S REgUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND i4- <br /> - PRESERVATIONnSAMPLE <br /> 6Y S 8x <br /> r"`!i NOTES ASSIGNED CONDITION <br /> BOTTLE UPON <br /> D TE TIME SAMPLE ID NUMBERS RECEIPT NOTES <br /> X7-7- k I C�taa aPs <br /> -7- 7r I 2- <br /> I q(4 <br /> NOTES 1 MISCELLANEOUS It bed y (Signet ) , Re 'ed ,y (Signature) parte -Tim�r1 <br /> 5, O GAI`C Car 1X^ C6,%j4Z i-- �vC-e�,ft�.t�ISftxr� <br /> f Relinquished By (Signature) Received By (Signature) Date Time <br /> Ca r v� CX ckmyR cad Gr� e{{-ec r'l/f <br /> k �� 't Relinquished By (Signature) Received By (Signature Date Time <br /> Method of Shipment W ascription o/f, Other Chains Of-Custody Dispatched By (Signature) Date Time Received for lab By (Signature) Date Tt e <br /> Transport Container Transported with this <br /> Chain (by Serial No) <br /> Send Lab Results to (Name) -; hHP16PASey (Check Office w) Verbals Requested Yes No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER dOT1iE13 <br /> TEL(404) 951-0055 TEL(303) 790-1747 TEL(714) 757-1755 TEL(415)960-1640 TEL(219)926-8651 TEL $ 7 <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 ❑ 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)241-0282 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) 290-801371 <br /> SERIAL NO n WHITE Field Copy YELLOW Project Copy PINK Laboratory CGpy REV 8192 <br />