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M , <br /> CANONIE ENVIRONMENTAL - AIN-OF-CUSTODY RECORD PROJECT.& <br /> ' (See Reverse for Instructions) NO <br /> PROJECT NAME SAMPLERS PC r SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES • <br /> - 331 DESCRIPTION CODES A Ground water F oil, <br /> PROJECT NUMBER RINT) CJQ�� A 40•ml VOA Vial B Surface water G waste t Standard <br /> (SIGN) B Glass Liter E Sress Tube C Leachate H BlanwSplks 2 48 Hour <br /> RECORDER __ •.� C Plastic 5Mrnl F Other D Rinseats I Other 3 24 Hour <br /> (SM) t D Plastic Liter E Soll/Sediment 4 iOther <br /> Nk BER OF ANAL SIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS d Y <br /> AND O <br /> P ESERVATiON _ _ <br /> to ii SAMPLE 950 Z M�I <br /> uNOTES ASSIGNED CONDITION <br /> x � w � BOTTLE UPON <br /> DATE TIME SAMPLEID $ NUMBERS RECEIPT NOTES <br /> MW , <br /> e11,17 M W 7+ <br /> 13X0H Mw <br /> MW r <br /> 47 51 '771 <br /> tIff AAJW <br /> NOTES 1 MISCELLANEOUS R h gwshad (Signature) d qq (Signature) 03 D to 1600 <br /> �e <br /> ' Relln I ed By (Signature) Received By (Sig azure) Date Time <br /> Ir Relinquishe y (Signature) Received By (Signature) Date Time <br /> 1 <br /> LMethod of Shipment Description of Other Chains-Of-Custody Dispatched By (Signature) Date Time Received I r lab y (Signature) Date Time <br /> Transport Container Transported with this r <br /> !E YYtF� Chain(by Serial No) <br /> I S 14'r 1 <br /> 'Send Lab Results to (Name) !e "" r (Check Office Below) Verbals Requested Yes Iq No ❑ <br /> i❑ DALLAS ❑ DENV>=R Y ❑ IRVINE ❑ MT VIEW ❑ PORTER OTT <br /> TEL(214)770-1600 TEL(303)790-1747 TEL(714)757-1755 TEL(415)960.1640 TEL(219)926 8651 i. TEL <br /> ` FAX(214) 770-0249 FAX(303)799-0186 FAX(714)757-0960 FAX(415)960-0739 FAX(219)926-7169 FAX <br /> Q BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER <br /> TEL(406) 586-9496 TEL(713)589-8686 TEL(215)337-2551 TEL(510)463-9117 TEL(503)241-0282 TEL <br /> +> A'FAX(16)586-9724 FAX(713) 531-8886 FAX(215) 337-0560 FAX(510)463-2981 FAX (503)2410486 FAX <br /> r I "IFIONMENTAL SERVICES, CORP • TWO GALLERIA TOWER • 13455 NOEL ROAD, SUITE 1500 a DALLAS, TX 75240 • TELEPHONE (214) 7701800 a FAX(214)770-0249 <br /> SERIAL{ 0,1 WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV IV93 <br />