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�+ <br /> CANONIE ENVIRONMENTAL `LAAIN-OF-CUSTODY RECORD77 <br /> PROJECT <br /> (See Reverse for Instructions) NO, <br /> PROJECT NAME L1L6lJ F i? 1.f1PCRTy SAMPLERS ALEX FL l SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PRIN - DESCRIPTION CODES A. Ground Water F. Oil <br /> PROJECT NUMBER 9 S-12sZ '�4I- Tr <br /> 4� �. - �✓ A. 40-ml VOA Vla! B. Surface Water G. Waste 1. Standard <br /> (SIGN) B. Glass Liter E. Brass Tube Leachate H. Blank]Spike 2. 48 Hour <br /> RECORDER C. Plastic 5170-ml Other M [�` Rinseate I. Other a 24 Hour <br /> (SIGN) D. Plastic Liter t E. Soil/Sediment a Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS u <br /> AND c m Q <br /> a PRESERVATIONY �8 m R m^mY <br /> a o, F, gm S Edc =r SAMPLE <br /> J ° E=8 drag NOTES ASSIGNED CONDITION <br /> a = LLr `m s E ° BOTTLE UPON <br /> DATE TIME SAMPLE ID h h N z NUMBERS RECEIPT NOTES <br /> 610" IIS-0 T AM 11 13 <br /> 3 N 1 3o r A 11-111 r3 V It Z <br /> 31 IZ VJ-a A V kI I ✓ <br /> lEMU— <br /> LA <br /> w <br /> i y <br /> NOTES l MISCELLANEOUS p _ Relinq} (shed by: (Signature) R By: ignature) �7L Date Time <br /> Rp', t�O�a- - 1►1AAS 5 PPS °'� <br /> S <br /> 0` $~�'rf / Relinquished By: (Signature) ceived By: (Signature) Date Time <br /> Q\'I <br /> Relinquished By: (Signature) Received Si B Si Date Time <br /> Lh ra q� � W t�C]I,rr1}vtAa�o � v. (Signature) <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 /> Chain (by Serial No <br /> Send Lab Results to (Name): 6-11 L L i AIN► fy Ab1Sd1J (Check Office Below) Verbals Requested: Yes ElNo El <br /> lElATLANTA ❑ DENVER IRVINE ❑ MT VIEW ❑ PORTER 6?/ <br /> OTHER MtN 751-0 <br /> TEL(404)951-0055 TEL(303) 790-1747 TEL(714) 757.1755 TEL(415) 960-1640 TEL(219) 926-8651 TE1321� <br /> FAX (404)956-9364 FAX (303) 799-0186 FAX(714) 757.0960 FAX(415) 960-0739 FAX (219)926-7169 FA)04��j <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- <br /> SERIAL NO. 1 A F 4 n WHITE:Field Copy YELLOW:Protect Copy PINK:Laboratory Copy REV.8192 <br />