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CANONIE ENVIRONMENTA&RAIN-OF-CUSTODY RECORD AB PR04ECT <br /> (See Reverse for Instructions) <br /> A r <br /> PROJECT NAME �"' SAMPLERS NTN ot!V SGaAnA SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> _ <br /> IN <br /> 7 DESCRIPTION CODES A Ground Water F Oil + ' <br /> PROJECT NUMBER _ '� A 40-mi VOA Vial a Surface Water G Waste 1 Standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H BlankfSpike 2 48 Hour <br /> RECORDER C Plastic 500 ml F Other D Rmseale I Other 3 24 Hour <br /> (SIGN) ❑ Plastic Liter E SallSediment 4 Other <br /> NUMBER OF ANALYSA REOUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND O <br /> v a^ fi PRESERVATION 2 p <br /> SAMPLE <br /> n = J LLv L x F m $o NOTES ASSIGNED CONDITION <br /> DATE TIME SAMPLE ID �. = BOTTLE UPON <br /> W NUMBERS RECEIPT NOTES <br /> 46a l9 110H a A 9 All y <br /> 61 Iy <br /> 019 n,,,r s B A I <br /> I'll' /3-131 MW b d �. y INit V <br /> NOTES 1 MISCELLANEOUS Relinquished by (Signature) Re ived B Signature) Date Time <br /> Relinquished 13v (Signa ure) Received By (Signature) Date Time <br /> Relinquished B Aecel Signature) Date Time <br /> Method of Shipment Description of011ier Chains-Of-Custody Dispatched By (Signature) Date Time deceived for lab By (Signature) Date Time <br /> Transport Container Transported with this <br /> Chain (by Serial No) <br /> (657 <br /> Send Lab Results to (Name) - 0 S'P (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER �I OTHER <br /> TEL(404)951-0055 TEL(303) 790.1747 TEL(714)7571755 TEL(415) 960-1640 TEL(219)926 8651 TEL 2-64 r39-3xo� <br /> FAX(404)956-9364 FAX (303)799-0186 FAX (714)757-0960 FAX (415)960-0739 FAX (219)926-7169 FAX Ao Oq <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) 2410486 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP • 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 • TELEPHONE (303) 290-8336 a FAX (303) 290- <br /> SERIAL NO - Q �► WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV W2 <br />