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3/3 CANONIE ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LAB PROJECT <br /> (See Revers for Instructions) NO. T <br /> PROJECT NAME Ci A, 0 `-'�JC- ��✓` 14 SAMPLE S&PA'VU <br /> ' .�[Y� SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> roDESCRIPTION CODES A. Gund WaterF. Oil <br /> PROJECT NUMBER 7 5A. 41Ym1 VOA Vial B. Surface Water G. Waste �. staneara <br /> \ \ (SIGN) B- Glass Lila, E. Brass Tube C. Leachate H. BlanWSpike 2. 48 Hour <br /> RECORDER b • C. Plastic 500-m1 F.Other D. Rbseaw L Other _ a. 24 Hour <br /> (SIGN) D. Plastic Liter E Sail/sediment 4. Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND <br /> ag_g $5$g—g PRESERVATION �. 34 <br /> ae E_ <br /> g g$ LLm ;E� SAMPLE <br /> zE. nP_ __ +`-' g `-'<u NOTES ASSIGNED CONDITION <br /> DATE TIME SAMPLE ID _ Ao `a ' �� BOTTLE UPON <br /> y NUMBERS RECEIPT NOTES <br /> Le <br /> I <br /> 7 � <br /> f. <br /> NOTES l MISCELLANEOU!S� //�) {d el( ishe ;+(Sign re) R1 wed By: (Signature) Date Time <br /> -f-PA �10�4 IUr Yllon ���oFriclf /1I�fcr/S ,o A <br /> f Pb, /'�/ A/f/ c$/ 7j�f�//.�L� (flelnngl ishad� Signature) Re ived By: (Signature) Date Time <br /> s s 2 CSP r Ct, r rt 77 J l� �/r 7� W <br /> nn 1 Relinquished By: (Signature) Received By: (Signature) Date <br /> _ Time <br /> ? P I'A fifth Lf'roro .n Irl �1 lJ � PikA15M <br /> ethod of Ship ent D scdption of Other Chains-Of-Cus ody Dispatched By: (Signature) Date Time Received for lab By: (Signature) Date Time <br /> Transport Container Transported With this <br /> Chain (by Serial No.) 71 �II <br /> Send Lab Results to (Name): (Check Office Below) Ve als Requested: Yes," <br /> es No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT. VIEW ❑ PORTER 0 OTHER &T , e' <br /> TEL(404)951-0055 TEL (303) 790-1747 TEL(714) 757-1755 TEL(415) 960-1640 TEL(219)926-8651 TEL r1?2_( <br /> FAX(404) 956-9364 FAX (303) 799-0186 FAX(714) 757-0960 FAX (415) 960-0739 FAX(219) 926-7169 FAX2 Z ?S <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) 290-8013 <br /> SERIAL NO 1 <br /> A r 4 WHITE:Field Copy YELLOW:Project Copy PINK:Laborabry Copy REV e92 <br />