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CANONIE ENVIRONMENTAWHAIN-OF-CUSTODY RECORD 4LB PROJECT , <br /> r �', �, (See Reverse for instructions) NO ` <br /> PROJECT NAME K(�AZW - SAMPLERS t 1� 3rM SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> ��jj1nff1�.��(PR l DESCRIPTION CODES A Ground water F oil <br /> PROJECT NUMBER L�IJ ,L A 40-ml VOA Vial B Surface Water G Waste 1 Standard <br /> I (SIGN) 9 Glass Liter E Brass Tube C Leachate H BlankJSplke 2 48 Hour <br /> RECORDER C Plastic 500-ml F Other 0 Rinseate I Other 3 24 Hour <br /> (SIGN) D Plastic f-iler E SoillSedimenl 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND $� + <br /> PRESERVATION <br /> 4 <br /> �� <br /> � �� SAMPLE <br /> $ NOTES ASSIGNED CONDITION <br /> r€ w 3�°v BOTTLE UPON <br /> D TE TIME SAMPLE ID 2 NUMBERS RECEIPT NOTES <br /> -3 ! <br /> E <br /> I <br /> A40 A 5 <br /> _4F _j <br /> NOTES 1 MISCELLANEOUS I ej bjASig We) Deceived By IS ure) [[II Date Time <br /> r �b� , o <br /> Relinquished by (Signature) Received By (Signature) Date 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 /> Transport Container Transported with this <br /> Chain (by Serial No) <br /> Send Lab Results to (Name) (Check Office Below) Verbals Requested Yes ONo ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER OTHER <br /> TEL(404) 951-0055 TEL(303) 790-1747 TEL(714) 757-1755 TEL(415)960-1640 TEL(219)926-8651 TEL �] <br /> FAX (404)956-9364 FAX (303) 799-0186 FAX(714)757-0960 FAX(415)960-0739 FAX(219)926-7169 FAX <br /> 0 BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER I <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) 566-9724 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 /> SERIAL NO w t_ r' r) 1 WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV 8192 <br />