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( CANONIE ENVIRONMENTAL( 4AIN-OF-CUSTODY RECORD \B PROJE& <br /> (See Reverse iur Instructions) N <br /> PROJECT NAME &OV0 2 F24PEe.1V SAMPLERS 14Lc)e r LO tach SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PRI "' DESCRIPTION CODES A. Ground Water F. Oil <br /> PROJECT NUMBER 2 2 ©I Q I 'A LL J,,%/ A. 40-ml VOA Vial B. Surface Water G. Waste 1. Standard <br /> (SIGN) B. Glass Liter E. Brass Tube C. Leachate H. Blank/Spike 2. 48 Hour <br /> RECORDER C_ Plastic 5Wm1 F.Other D. Rinseate I. Other 3. 24 Hour <br /> (SIGN) D_ Plastic Liter ._ E. Soil/Sediment __ 4. Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> L) <br /> AND <br /> ° PRESERVATION $_ dg 8y <br /> fZ a� r SAMPLE <br /> e TES A <br /> NOTES CONDITION <br /> 4 S Y {� �� a o- BOTTLE UPON <br /> DATE TIME SAMPLE ID (10 z NUMBERS RECEIPT NOTES <br /> 3+7751, &50Mw- A R v I 1DAS v-P <br /> b Mw-Z A A I ✓ Y <br /> 2 <br /> 1100 Mw- A tV I <br /> TS VA <br /> NOTES/MISCELLANEOUS - -�ET6(.T��r� 50pp6 S� Relinquished by: (Signature) Received By: (Si nature) D to Time <br /> ►°it8: R, QI`� �a d 5 r 23 :00 <br /> " 1 �n QI PPb TOS 131t-1(. Relinquished By: (Signature) Received By: ( ignature) D Time <br /> `PLEwtSE 1�¢ "'OE COPIES of <br /> 64"MAT0612-AMS W tTN II Relinquished By: (Signature) Received By: (Signature) Date Time <br /> C,MWrAATb6RAAA5 STINIJbAeb:!! <br /> Method of Shipment Description of Other Chains-Of-Custody Dispatched By: (Signature) Date Time Received for lab By: (Signature) Date Time <br /> e4O1-0 Transport Container Transported with this <br /> N 6JJ9 12 Chain (by Serial No.) <br /> &0Lg:,;!P_ N AA- oy2,16 //s-S, <br /> Send Lab Results to (Name): QI,Lt-I A►tit MA-D ISG (Check Office Below) Verbals Requested: Yes ❑ No El <br /> 1:1 El DENVER El IRVINE El MT. VIEW El PORTER `PJ OTHER MUD <br /> TEL(404)951-0055 TEL (303) 790-1747 TEL(714) 757-1755 TEL(415) 960-1640 TEL(219) 926-8651 TEL w1 -S <br /> FAX(404)956-9364 FAX (303) 799-0186 FAX (714)757-0960 FAX(415)960-0739 FAX (219) 926-7169 FAX Q'22Z� <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 r,i R 7 'y WHITE:Field Copy YELLOW:Project Copy PINK:Laboratory Copy REV.11192 <br />