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r <br /> CANONIE ENVIRONMENTAL LRAIN-OF-CUSTODY RECORD PROJECT <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME Fc�1 V&6fodh WE GQX SAMPLERS SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> r IN DESCRIPTION CODES A Ground Water F Oil <br /> PROJECT NUMBER !7 dLSI�„DDD f A 40-ml VOA Vtal B Surlace Water G Waste 1 Standard <br /> (81G14) B Glass Liter E Brass Tube C Leachate H BlanklSpike 2 48 Hour <br /> RECORDER C Plastic 500 mt F Other D Rinseate I Other 3 24 Hour <br /> (SIGN) D Plastic L4er E SodlSedimenl 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS O <br /> m o AND & a <br /> s Sm PRESERVATION $ 111.6 <br /> m <br /> �g LL� 1 g� �tI a� =t SAMPLE <br /> ` m o 25 �� m au NOTES ASSIGNED CONDITION w <br /> ap = 1! 00 � °w BOTTLE UPON <br /> DATE TIME SAMPLE ID � ~ ? 4 j z NUMBERS RECEIPT NOTES <br /> UJ <br /> W <br />�r <br /> kit Ij 1.0 <br /> 4r 1111,11VA <br /> 3 <br /> LL <br /> NOTES 1 MISCELLANEOUS Relinquished by (Signature) Rec lved By (Signature) Date Time <br /> r <br /> Relinquy1ished By (Signature) Rec d By (Signature) to i e <br /> W <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> x <br /> Method of Shipment es nption o ~ Other C ams f- ust y Ispatched By (Signature) DTime Received for lab By (Signature) Date Time <br /> Transport Container Transported with this <br /> G�1. Chain (by Serial No , of 2 ate <br /> 0,A,i n i g 0 / 4.12 4.1 / g, <br /> Send Lab Results to (Name) (Check Office Below) Ver6ls Requested Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER EXOTHER <br /> TEL(404) 951-0055 TEL(303) 790-1747 TEL(714) 757-1755 TEL(415) 960-1640 TEL(219)926 8651 TELTle 11 -A f <br /> FAX (404)956-9364 FAX (303)799-0186 FAX(714)757-0960 FAX(415) 960-0739 FAX(219)926-7169 FAX ._ <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA " Q 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 (610)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 /> SERIAL NOA ^ WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV 8192 <br /> (� 1 1 ' <br />