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r <br /> CANONIE ENVIRONMENTA HAIN-OF-CUSTODY RECORD *13 PROJECT ' <br /> _ J /� (See Reverse for Instructions) NO <br /> PROJECT NAME )6; U+ / /� SAMPLERS_1��-T oAo S c 4- SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> P NT) S DESCRIPTION CODES A Ground water F oil <br /> PROJECT NUMBER y - 3 A 40-ml VOA Vial B Surface water a waste 7 Standard <br /> p� (SIGN) B Glass Liter E Brass Tube C Leachate H Blank/Spike 2 48 Hour <br /> RECORDER ___/" C Plastic SMml F Other D Rmaeate I Other 3 24 Hour <br /> (SIGN) D Plastic Liter E SoillSedlment 4 Other <br /> NUMBER OF ANALXSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND Q <br /> a <br /> PRESERVATION ^ 2g <br /> 8 <br /> $ r 8 <br /> SAMPLE <br /> U h$ � - � NOTES ASSIGNED CONDITION <br /> BOTTLE UPON <br /> DATE TIME SAMPLE ID I € NUMBERS RECEIPT NOTES <br /> Jos 1 �-1J< 1 ,tn w A 2- f 4&t -10 <br /> NOTES 1 MISCELLANEOUS Relinquished by-1Signature) R elved-By (Signature) Date Time <br /> � �� � /d-z4r <br /> Relinquish By (Signature) Received By (Signature) Date Time <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> Method of Shipment Description of Other Chains-011-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 /> ..(,e-yQ,,? a3dw l6sD <br /> Send Lab Results to (Name) / !04,�- <br /> t..— 117' (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ DALLAS ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER 1r71 OTHER <br /> TEL (214) 7701800 TEL(303) 790-1747 TEL(714) 757-1755 TEL(415)960.1640 TEL(219)926 8651 TEL P"-61' PIP- <br /> FAX(214)770-0249 FAX(303) 799 0186 FAX(714)757 0960 FAX(415)960-0739 FAX(219)926-7169 FAX o 9 <br /> ❑ 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 /> FAX(406)586-9724 FAX(713) 531-8886 FAX (215)337-0560 FAX(510) 463 2981 FAX (503)241-0486 FAX <br /> I CANONIE ENVIRONMENTAL SERVICES, CORP • TWO GALLERIA TOWER • 13455 NOEL ROAD, SUITE 1500 • DALLAS, TX 75240 • TELEPHONE (214) 7701800 • FAX (214) 7700249 <br /> SERIAL NO „ n WHITE Field Copy Copy YELLOW Project CoPINK Laboratory.f I I Ca pY REV 11193 <br />