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r r t• r r r r r r r r r r r r r r <br /> CANONIE ENVIRONMENTAL LAIN-OF-CUSTODY RECORD A PRDcT <br /> (See Reverse for Instructions) NO. f �LI_C <br /> PROJECT NAME 6t,Qfi<.(' 0-40f Vj t� SAMPLERS Alex SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> , Q ,,(P-RIN•T DESCRIPTION CODES A. Ground Water F. Oili <br /> PROJECT NUMBER - 1?.Z I � �"� A. 40-ml VOA Vial B. Surface Water G. Waste 1. Standard <br /> (SIGN) B, Glass Liter E. Brass ub f Leachate H. Blank/Spike 2. 48 Hour <br /> C. Plashc 500-ml [h r�9('�)04 C S . <br /> RECORDER �F _Lyj Ri l/Sedi I. Other 3. Other Hour <br /> (SIGN) D. Plastic Liter �1— E. SoillSetlimen! 4. Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> m a AND <br /> m _ PRESERVATION <br /> Q e s $Y SAMPLE <br /> 3u x [� c ¢e E r$ P�� NOTES ASSIGNED CONDITION <br /> E E° = LL ` 2 EZ BOTTLE UPON <br /> DATE TIME SAMPLE 0N " NUMBERS RECEIPT NOTES <br /> 3 v I a r' NOTL:CUz 1 L� <br /> CQZ%�2� M -7,, A '31 t� F' v ✓ ✓ 4�0 ��a rc 3. 1 <br /> 3 3 kf t/✓ 1/d 1 ✓ ✓ � 1u+} lnalc tir <br /> tlrfrr,y,A E tp1 <br /> �Y5• <br /> Ck Y{v� <br /> NOTES I MISCELLANEOUS J�. e�� Relinquished by: (Signature) Received By: (Signature) Date Time <br /> Relinquished By: (Signature) Received By: (Signature) Date Time <br /> 3 X , LcR ` �t2p,tko� <br /> LO�IFS O C.4.re)v�q�oc�t�g„v�S Relinquished By: (Signature) Received By: (Signature) Date Time <br /> ti.11�'`, C'tlsdwtq�t0 Yty,1U ,]�lkYl�(A+tl45Y <br /> Method of Shipment Description of Other Chains-OfCustody Dispatched By: (Signature) Date Time Receive for ab By (Signature) Date Ti a_ <br /> Transport Container Transported with this I <br /> Chain (by Serial No.) (� r. _ <br /> Send Lab Results to (Name): VA �,A�I3 i Sri t (Check Office Below) Verbals Requeste : Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT. VIEW ❑ PORTEROTHER S I O <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 FA <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 />