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-F B PRo�ECT <br /> CANONIE ENVIRONMENTAL �. IAIWOF-CUSTODY RECORD <br /> (See Reverse for Instructions) No. <br /> PROJECT NAME„6090R ��P��� Y SAMPLERS -ex SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES', <br /> DESCRIPTION CODES A. Ground Water F. Oil c }, <br /> PROJECT NUMBER T r- A. 40-m1 VOA Vial B. Surface Water G. Waste' 1:Standard ' <br /> _ (SIGN} - B.'GlassLiter E. Brasajurbe ti C Leachate H.-BlankJSpike�. 2, 4B Hour_ <br /> ' ” ` - - C. Plastic 500-m1 .-gther cSt"�`�4 TD, Rinseate I. Other 3s2a Hour, <br /> RECORDER (�; <br /> . ,+(SIGN) - - D:=Plastic Liter <br /> ��- E. SoiUSediment �,; a.�Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY - <br /> CONTAINERS <br /> • <br /> r. Fr <br /> a AND 8 <br /> _._ - •r r .4,�. m g.PRE5ERVATIQN $^ ! { <br /> E s`�=��d T r SAMPLE <br /> m� ,ri. a� k t _ �� EP _ "�au ..::NOTES - ASSIGNED <'- CONDITION =r� ^ <br /> 6..� �.ac am-m z mom• - -a 4m ,-._� O L <br /> f: R Em z - r 3 2 BOTTLE UPON <br /> DATE TIME SAMPLE II] N I z NUMBERS' RECEIPT _ '' ' NOTES <br /> IZ4 % 1117 43 v v f/. ! Cn 5 ✓ f-J, c� C f I.t d <br /> 16`rb I M A--3 ✓ VIVI P11 t� ✓414,r <br /> Zib 11NW- A 3 ✓ ✓ v V1 I ✓ v ✓-�, r13s . <br /> 'x:r�t+uS <br /> 6`. Ypr W <br /> NOTES 1 MISCELLANEOUSIb� �c5aRelinquished by: (Signature) Received By: (Signature) Date Time <br /> �r� l-;�h l�w�.��s; b S' � , z l <br /> r ph T°Y BTE.K r' PL�c,�Qr j Relinquished By: (Signature). Received By: (Signature),. Date Time <br /> Colpte�-'- ClkC�{Owt41 �Otn.S Ct <br /> C a9M—^9. SlVay\c%,, ,qtblinquished By: (Signature) :: Received By: (Signature) • Date . . Time <br /> 1NiT�G -:+�eec� !' $020 C.�11 w�l��awt. �tou.t.�'krw�a�,a� E 'A�SzKJ rv+ 6e (ruduc�J. <br /> 'Method of Shipment Description of Other Chains-Of-Custody Dispatched By: (Signature) Date Time Received tot lab By (Signature) Date Time <br /> Transport Container Transported with this <br /> Chain (by Serial No r V ( <br /> Send Lab Results to (Na'trie):' ' ' lie) (Check Office Below) Verbals Requests Yes,❑ No L],- <br /> 0 <br /> ❑ ATLANTA ❑ 'DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER i ° OTHER,�O-6STU <br /> TEL(404)951.0055 t, TEL(303)790-1747. TEL(714)757-1755 TEL(415)960-1640 TEL(219)926-8651 ,, r TELL C'_ <br /> FAX(404)956-9364 1 -(303)799-0186 ; FAX{714) 757-0960 FAX (415)960-0739 FAX(219) 926-7169 ii .; FAX T G 5 <br /> ❑ BOZEMAN ❑ HOUSTON _❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND t `❑ OTHER' <br /> TEL(406)586 9496 TEL(713) 556 1666' TEL(215) 337-2551 TEL (510)463-9117 TEL(503)241-0282 , ,` f y TEL' <br /> PAX(406)586.9724 ; f 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,NQ, -1 R f% 1 M WHITE:Field Copy YELLOW:Project copy PINK:Laboratory Copy REV.8792 <br />