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---------- <br /> CANONIE ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LAB PROJECT <br /> (See Reverse for Instructions) NO.� <br /> PROJECT NAME rCQ t t} SAMPLERS e-e-t,D.kc�eet,, SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> _ (PRI DESCRIPTION CODES A. Ground Water F. Oil <br /> PROJECT NUMBER t A. 40-mi VOA vial B. Surtace water G. Waste t. standard <br /> (SIGN) B. Glass Liter E. Brans Tube C. Leachate H. Blank/Spike 2, 48 Hour <br /> RECORDER C. Plastic 540-mi F.Other D. Finalists I. Other 3, 24 Hour <br /> (SIGN) 0. Plastic Llter E. SolilSediment 4. Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS u <br /> $g PRESERVATION _ <br /> $ <br /> SAMPLE <br /> 3: LE <br /> F NOTES ASSIGNED <br /> D UPON <br /> DATE TIME SAMPLE ID I TfNUMBERS RECEIPT NOTES <br /> UOl +� 2i' t 451 <br /> `a. <br /> Ar <br /> NOTES/MISCELLAN OUS 6 Relin (shed LM (Signature) eiv By Sign re to Time <br /> Relinquished By: (Signature) eceived By: (Signature) Data Time <br /> Relinquished By: (Signature) Received By: (Signature) Data Tirne <br /> Method of Shipment Description of Other Chains-Of-Custody Dispatched By: (Signature) Date Time Received for lab By: (Signature) Data Time <br /> Transport Container Transported With this �' a <br /> Chain(by Serial No.) `Y <br /> Send Lab Results to (Name): LOLs r 1.4 ,Loi (Check Office Below) Verbals Requested: Yes ❑ No ❑ <br /> ❑ PORTER ❑ SAN MATEO ❑ IRVINE ❑ ORLANDO ❑ OTHER <br /> TEL(219)926-8851 TEL(416) 673-8012 TEL(714)757-1755 TEL(4017)856.7428 TEL <br /> FAX(219)926-7169 .FAX(415)573 FAX(714)757 FAX(407)855-2595 FAX <br /> ❑ DENVER ❑ KING OF PRUSSIA ❑ HOUSTON ❑ MT. VIEW ❑ OTHER <br /> TEL(303)790-1747 TEL(215) 337-2551 TEL{713} 558-1888 TEL(416) 1640 TEL <br /> FAX(303) 188 FAX(215)337-0580 FAX(713)55 FAX(416) 980-0739 FAX <br /> CANONIE ENVIRONMENTAL LABORATORY a 212 FRANK WEST CIRCLE, SUITE A e .g.TOCKTON, CA 95206 s TEL. 209 983-13440 a FAX 983-0304 <br /> SERIAL NO. n i 0,497 <br /> WHITE:Field Copy YELLOW:Praiact Copy PINK:Laboratory Copy <br />