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'bAMNff%NMOAWEIXL IMAIN%F.Thf% %C N VROJ" <br /> (� (See Reverse for Instructions) NO <br /> fi <br /> PROJECT NAME «'-0� 5aw SAMPLERS �NT�1"^�f_�'�Gu+ ±- SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> G+ _ IPp n DESCRIPTION CODES A Ground water P Oil <br /> PROJECT NUMBER_— _ " X B A 40-mi VOA Vial B Surface water G waste 1 Slandard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H Blank/Spike 2 48 Hour <br /> RECORDER C Plastic 5D6ml F Other O Rinsoate I other 3 24 Hour <br /> (SIGN) l7 Plastic Liter E Soil!Sediment 4 Other <br /> i <br /> ` NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> [� AND <br /> PRESERVATION <br /> rL r I; H_ SAMPLE <br /> NOTES ASSIGNED CONDITION <br /> DATE TIME SAMPLE IDBOTTLE UPONr NUMBERS RECEIPT NOTES <br /> A ! <br /> .k ro,. 4w - b I 1 I 'IVy O <br /> 3 A A < v <br /> ra0rgs' 133T Oct Cola �+ AA%r., S h A I I v oS <br /> /r,��x /3os cn - cues Mw la �D A I I <br /> LL I I <br /> NOTES 1 MISCELLANEOUS Relinquished by (Signature) ed By (Signature) D to Time <br /> Relmqui hed By (Signature) Received By (Signature) Date Time <br /> laslm y (Signature) Received B ure} Date <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 al <br /> Chain (by Serial No) <br /> L <br /> Ir. 1 Gam„ �O G t,,s / v,T' 1`17 <br /> / <br /> Send Lab Results to (Name) /u rr (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER GiI OTHER <br /> TEL(404)951-0055 TEL(303) 790.1747 TEL(714) 757-1755 TEL(415)960-1640 TEL(219)926-8651 TEL�u1 S?S r o 7 <br /> FAX(404) 956.9364 FAX(303) 799-0186 FAX(714) 757-0960 FAX(415)960-0739 FAX(219)926-7169 FAX A u 4 r T s 7 r t q <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)241-0282 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 (303) 290-8336 • FAX (303) 290-8013 <br /> SERIAL NO a1 ) ('1 WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV 8192 <br /> 1 ' <br />