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CANONIE ENVIRONMENTAL\ HAIN-OF-CUSTODY RECORDS PROJECT <br /> (See Reverse for Instructions) NO. <br /> PROJECT NAMEP- ERT SAMPLERS ALCx TLc a e SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> ��77 O `' PRINT) DESCRIPTION CODES A. Ground Water F. Oil <br /> PROJECT NUMBER `�0-L�4 ,d o o2- A� A. 40-m1 VOA Vial a. Surface water G. waste 1. Standard <br /> (SIGN) B. Glass Liter E. Brass Tube C. Leachate H. BlanktSpike 2. 48 Hour <br /> RECORDER C. Plastic 500-m1 F.Other D. Rinseale I. Other 3. 24 Hour <br /> (SrGN) D. Plastic Liter E. SDIIlSedlment 4. Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND 1 A 3 <br /> am g PRESERVATION �e a- <br /> 8 SAMPLE <br /> NOTES ASSIGNED CONDITION <br /> � = _ °V BOTTLE UPON <br /> DATE TIME SAMPLE ID A N z NUMBERS RECEIPT NOTES <br /> MIL'Al 1 411r! t ✓ Fnr <br /> OO /030 W-2 1 <br /> 1020 JAW-3 ✓ <br /> • <br /> NOTES IMISCELLANEOUSNI`� CH�vrt� r �S an r Relinquished by: (Signature) R ived By: (Si nature) Date Time <br /> p9 -lilo, <br /> yjeaje--ptw,II f Relinquished By: (Signature) Re ived By: (Signature) Date Time <br /> �Qi Q.S of C.L.�rt3vu�a1 q�1pL6v.g W�Ghxo �pt�S <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 /> EL,, Chain (by Serial No.) <br /> tC(Lmoo - �LK,7-&,MV 0912-97 <br /> Send Lab Results to (Name): P4N (Check Office Below) Verbals Requested: Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER OTHER 14 DDUSTO <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 F <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ 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 (510)463-2901 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. ^ WHITE:Field Copy YELLOW.Prolecl Copy PINK:Laboratory Copy REV.BM2 <br />