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CANONIE ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD ---LAB PROJECT <br /> ,,p ,'l (See Reverse for Instructions) <br /> PROJECT NAME 1r1/L'%+'a Awn 01A 2 SAMPLERS SAMPLE CONTAINERAMPLE DESCRIPTION CODES TAT CODES <br /> (PRIN DESCRIPTION CODES Ground Water F. On <br /> PROJECT NUMBER [y -?- QS �- Aa A. 4 l VOA Viel . Surface Water G. Waste 1. stamard <br /> (SIGN) e. (elms LiterE. Bram lube Leachate H. BlanWSpike 2. 49 Hour <br /> RECORDER C. Plastic 500.,1 F.Other_1 Rinmate I. Other 3. 24 Hour - <br /> (SIGN) D. Plants Liter SoiVSedi,ent 4.Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS 4t <br /> ND Mpp <br /> �88 5Y- PRESEARVATION 8 ( N 80 a r\ <br /> rYm 8 or I € SAMPLE <br /> a£ am g — NOTES ASSIGNED CONDITION <br /> DATE TIME SAMPLE ID �V `a a ' g` BOTTLE UPON <br /> NUMBERS RECEIPT NOTES <br /> 1 ) <br /> ;H W $S <br /> I' # z vi12 <br /> u <br /> S'2 <br /> NOTES MISCELLANEOUS q 111; r �1m elinquished b : (Sign ure) ei By: ( 'g ture) Dpt Time <br /> 5'tte �odi T�Nt t f}t1NrN� 1J ri u/ �JSraL �� <br /> )(o � R ek iLr iN OLO (' lad Q. � erin Disned B <br /> q y: (Signature) 'Received By: l nat re Date Time <br /> hod� C'A` . 9521-/0 <br /> Relinquished By: (Signature) Received By: (Signature) Date Time <br /> - 55 <br /> Method of Shipment Description of Other Chains-Of-Custody Dispatched By: (Signature) Date Time Received for la y:( ' ur ) ate Time <br /> Transport Container Transported with this <br /> Chain (by 4rial No.) v <br /> Send Lab Results to (Name): (Check Office Below) erbals equested:/Yes ❑ No ❑ <br /> ❑. PORTER ❑ SAN MATEO ❑ IRVINE ❑ ORLANDO ❑ OTHER <br /> TEL(219) 926.8651 TEL(415)573-8012 TEL(714)757-1755 TEL(407) 856-7428 TEL <br /> FAX(219) 926-7169 FAX(415)573-5654 FAX(714) 757-0960 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)556-1666 TEL(415)960-1640 TEL <br /> FAX(303) 799-0186 FAX (215) 337-0560 FAX(713) 556-0666 FAX(415) 960-0739 FAX <br /> CANONIE ENVIRONMENTAL LABORATORY - 212 FRANK WEST CIRCLE, SUITE A - STOCKTON, CA 95206 - TEL.(209) 983-1340 - FAX (209) 983-0304 <br /> SERIAL NO. 0-3381 <br /> WHITE:Field Copy YELLOW:Project Copy PINK:,Laborstory Coq <br />