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CANONIE ENVIRONMENTAL liAIN-OF-CUSTODY RECORD . B PROJECT <br /> (See Reverse for Instructions) NO. <br /> PROJECT NAME 6LIDV Ee- �-�PF'�'1 r SAMPLERS AL" , rc,,ap—z5 SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> DESCRIPTION CODES A. Ground water F- oil <br /> PROJECT NUMBER qS- — }� A. 40-ml VOA Vial B. Surface Water G. Waste 1. Standard <br /> (SIGN) B. Glass Liter E. Brass Tube . grhats H. Blank/Spike 2. 40 Hour <br /> RECORDER C' Plastic 500-mi F.Otharl Melia I. Other 3. 24 Hour <br /> (SIGN) D. Plastic Liter .� E. SoillSediment 4. Other <br /> NUMBER OF ANALYSIS RE UESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> `m c AND 1 `r. m_ g' d m <br /> A,g fim PRESERVATION 8 J.0 <br /> ;E SAMPLE <br /> • ¢ E~ NOTES ASSIGNED CONDITION <br /> DATE TIME SAMPLE ID NTV • Q m BOTTLE UPON <br /> J <br /> N Z NUMBERS RECEIPT NOTES <br /> pk3n 030 IV ✓ <br /> 20 ►+a-Z• 4 -31 �' �' ✓ b �CA <br /> 6M7 mid-"s 3 <br /> G'wx <br /> NOTES l MISCELLANEOUS �eN u• �. ��S �� �r P Relinquishee-bjur�) R eived By: (Si nature) Date Time <br /> 6 ' - 06139 7 <br /> Relinquished By: (Signature) Received By: ( gnature) Date Time <br /> Qt Q,*,r.&,L. ite a� rower rx <br /> cet.5 SUL-A Relinquished By: (Signa ure) Received By: (Signature) Date Time <br /> 7 i � <br /> Method of Shipment Description of Other Chains-Of-Custody ispatched By: (Signature) Date Time, Received for lab By: (Signature) Date Time <br /> 00-f-A ,,, Transport Container Transported with this <br /> Chain (by Serial No.) <br /> Send Lab Results to (Name): -� IV N`� J90 M 3 Fy (Check Office Below) Verbals Requested: Yes ❑ No ❑ <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) 926-6651 TEL <br /> FAX(404)956-9364 FAX (303) 799-0186 FAX (714) 757-0960 FAX(415) 960.0739 FAX(219) 926-7169 FAX <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) 463-2981 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 /t r A r WHITE.Field Copy YELLOW.Project Copy PINK:Laboratory Copy REV_0192 <br />