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CANONIE ENVIRONMENTAlkHAIN-OF-CUSTODY RECORD *AB PROJECT <br /> �f _- (See Reverse for Instructions) NO <br /> PROJECT NAME/�"% J41" „/n. 00A SAMPLERS___AA Nps fC*AU SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PRINT) DESCRIPTION CODES A Ground Water F OilPROJECT NUMBER 4-1t;_73 3' I TArk_6%f RK A 40-m1 VOA Vial B Surface Water G Waste t Standard <br /> (SIGN) a Glass Liter E Brass Tube C Leachate H BlanWSpike 2 49 Hour <br /> RECORDER C PIesllc 5DD•Ml F Other D Rinseale I Other 3 24 Hour <br /> (SIGN) D Plastic Liter E SoillSedimeni 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS Y <br /> AND g <br /> — $ PRESERVATION 44 �: g$: <br /> H$ k� 0 H � Y SAMPLE <br /> NOTES ASSIGNED CONDITION <br /> BOTTLE UPON <br /> DATE TIME SAMPLE ID it NUMBERS RECEIPT NOTES <br /> fig aa9 asKIR AW A,B AI a 1 13, l il <br /> t <br /> NOTES!MISCELLANEOUS Relinquished by Signature) a elved By Signat e) Date Time <br /> ot;aAA6,M, <br /> ?c ] a <br /> *4VA, Relinqu d By (Signature) Received By (Signature) Date Time <br /> ' c <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 /> t Chain (by Serial No) <br /> Send Lab Results to (NaMe) ZA4-~->r- (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER Nr OTHER <br /> TEL(404) 951-0055 ',TEL(303) 7901747 TEL`(714)757-1755 TEL(415)960.1640 TEL(219)926-8651 TEL 2-601- Mr.7T <br /> FAX(404)956-9364 FAX(303)79"186' FAX(714)757-0960 FAX(415)960-0739 FAX(219)926.7169 FAX Q-fA-*?f-3 s 0 <br /> ❑ BOZEMAN ❑ I HOUSTON l; ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER <br /> TEL(408)586.9496 ;TEL(713)48.1666 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)241-0486 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 1 r r^ 1 'y WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV-M2 <br />