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CANON IE ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD m LAB PR CT' <br /> II � ``\` � (See ev se for Instructions) NO . <br /> PROJECT NAME. .J.,d J �M1 X 0 h SAMPLERS SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> tl RINT) DESCRIPTION CODES A. Ground Water F. Oil f <br /> �^ +7 A. 42 m1 VOA Vial B. Sudace Water G. Waste t i 1 , standard <br /> PROJECT NUM ER __._) - �` <br /> (SIGN) B. Glass Liter E. Brass Tube C. Leachate H. Blank/Spike 2. 46 Hour <br /> �. <br /> C. 'Plastic F. Qthersi D. Rinseate ' I. Other 3. 24 Hour <br /> Liter <br /> RECORDER - D. Plastic Liter E. sontsetlimem rr 4. omar <br /> (SIGN) <br /> NUMBER OF �A Y$ <br /> I REQUESTED LABORATORY USE ON Y <br /> CONTAINERS O $ <br /> 5 AND `-15 <br /> m ". <br /> 53 PH SERVATION d_ m v$ EE a bo :m SAMPLE <br /> as f - E � "� <8 NOTES ASSIGNED CONDITION <br /> « BOTTLE UPON - <br /> DATE TIME SAMPLE ID -' C NUMBERS RECEIPT NOTES <br /> � I 2 <br /> V.� <br /> �t 2 <br /> -h> <br /> z <br /> i <br /> NOTES1./ MISCELLANEOUS—r^ I _ elinquis by: (Si nature) elC if By: Signa ure}� ,.p�to Time <br /> StIE� r Cad 14 � F �r /J � I IaZ <br /> 0)4) _ Relinquished 8y: ( ' lure) Received By: (Signature) Date Time <br /> Relinquished 8 (Signature) Received B Si nature Dafe Tir <br /> Snr � � � q Y� ( 9 ) Y� ( 9 ) <br /> Method of Shipment Descriptwf '}.,. Other Chains-Of-Custody ispdtched By: (Signature) Dateti Time Received fo lab By: (Signature) to Time <br /> /I� Transport Container s,Transported Th this <br /> C ' n hai al No ) <br /> � �S -l} 9 <br /> I�r Y,�iY(xI J � ' [ <br /> . Send Lab Results t0 (Name): (Check Office Below) Verbals Requested: Yes ❑ No ❑ <br /> ❑ PORTER ❑ SAN MATED ❑ IRVINE ❑ ORLANDO ' ❑ OTHER <br /> TEL (219) 926-8651 TEL (415) 573-8012 TEL (714) 757-1755 TEL (407) 856-7428 TEL <br /> ' t FAX (219) 928.7168 FAX (415) 573-5654 FAX (714) 757-0960 FAX (407) 855-2595 FAX <br /> ❑ DENVER ❑ KING OF PRUSSIA ❑ HOUSTON . El MT VIEW El OTHER <br /> TEL (303) 790.1747 TEL (215) 337-2551 . 1 , TEL (713) 556-1666 - - , . .q - - - --' TE <br /> L).(415) 960-1640 TEL , <br /> FAX (303) 799-0186` " FAX (215) 337-0560 FAX (713) 556-0686 +'.. �' . FAX (415) 960-0739 FAX <br /> CANONIE ENVIRONMENTAL LABORATORY • 212 FRANK WEST CIRCLE, SUITE A • STOCKTON, CA 95206 • TEL.(209) 983-1340 • FAX X09 983.0304 /r , <br /> SERIAL NO. _ WHITE: Reld Copy YELLOW: Project Copy . PIN,I�il.eboratar%kcopY' <br />