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CANONIE ENVIRONMENTAL41HAIN-OF-CUSTODY RECORD &B.PROJECT <br /> (See Reverse for Instructions) NO _ <br /> PROJECT NAME OLT ;TtFeS SRJLISAMPLERs ALtFX lloiQES SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> g�-331 OI'CSO {PRINT).— DESCRIPTION CODES A Ground water F Oil <br /> PROJECT NUMBER ]d � �✓ A 40-mi VOA Vial B Surface water G waste I Standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachale H BlanWSPlke 2 48 Hour <br /> RECORDER C Plastic 500-mi F Other O Rmseale i Other 9 24 Hour <br /> (SIGN) 0 Plastic Liter E SoillSedimerll _ 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> U <br /> AND c a <br /> $— PRESERVATION $^ 4� <br /> SAMPLE <br /> IK �c "D NOTES ASSIGNED CONDITION <br /> DATE TIME SAMPLE ID r � LL 1 F` r` `> BOTTLE UPON <br /> NUMBERS RECEIPT NOTES <br /> 7 et I Z3 7, 11 v <br /> 2 12Z w - MIA 2 <br /> i <br /> i <br /> NOTES I MISC LANEOUS Relinquished by (Signature) Receive By (SI nature Date Time <br /> Relinquished By (Signature) R Ived By (Signature) Data Time <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> Method of Shipment Description of Other Chains Of-Custody Dispatched By (Signature) Date Time Received for lab By (Signature) Date Time <br /> VGT2A Ir)( Transport Container Transported with this <br /> Chain (by Serial No) <br /> C4V2�E2f Up A �-R4L <br /> Send Lab Results to (Name) Jr.4 N S II (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER MOTHER 4402IIESM <br /> TEL(404)951-0055 TEL(303) 790-1747 TEL(714) 757-1755 TEL(415)9501640 TEL(219)926 8651 TELZ 1 <br /> FAX(404)956.9364 FAX(303) 799-0186 FAX (714)757-0960 FAX(415)960 0739 FAX(219) 926-7169 F <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) 2410282 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 - FAX (303) 290-8013 <br /> cFG141 rlrl '—— r -- n - - - <br />