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CANONIE ENVIRONMENTAHAIN-OF-CUSTODY RECORD AB PROJECT <br /> (See Revers ..r Instructions) N( <br /> PROJECT NAME �yGOVER N2oP a Ty SAMPLERS /4t is Y f-tti Rr'"5 SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PRI " DESCRIPTION CODES A. Ground Water F. oil <br /> PROJECT NUMBER O) 'n I �-` /�t5:- t ✓ A. 40-ml VOA Vial 8, Surface Water G. Waste 1. Standard <br /> (SIGN) B. Glass Liter E. Braes Tube C. Leachate H. BlankySpike 2. 48 Hour <br /> RECORDER C. Ptaslie 5Mml F.Other D. Rinseate 1. Other 3. 24 Hour <br /> (SIGN) D. Plastic Liter E. SoillSedimenl _.. 4. Other__ <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> tr <br /> AND 1 <br /> PRESERVATION <br /> M-1- <br /> SAMPLE <br /> NOTES ASSIGNED CONDITION <br /> BOTTLE UPON <br /> E SAMPLE IDDATE TIM z NUMBERS RECEIPT NOTES <br /> )qZ29 5 to w I <br /> 11t7zq I f M w z. p ;J — - — I l/ I/ '`�1"` —t-� <br /> rl7r:z96-I 100 Mw ?, ✓ 5 ✓ I ✓ ✓ S�ritPLl:- <br /> �,t('( k i'l L Z� <br /> U i'C r•J Lr�R <br /> K fL1 Vtr l— <br /> NOTES I MISCELLANEOUS Relinquished by: (Signature) R�clved By: (Si nature Time LTtUt� t %M%TS <br /> 1 I av)aI S P Pio Relinquished By: (Signature) Received By: (Signature) Date Time f <br /> ,P�e A St= 0\ItDE Ltap1Es nF <br /> GNrt ATQj6p A PAIS W ITµ it Relinquished By: (Signature) Received By: (Signature) Date Time <br /> LN►?O��NTUC>Q.N�titS STt�f,1UNk�S• <br /> Method of Shipment Description of Other Chains-Of-Custody Dispatched By: (Signature) Date Time Received for lab By: (Signature) Date Time <br /> ,1 eC'p n Transport Container Transported with this <br /> A ' l_OUR.teV2_ Chain (by Serial No.) e <br /> "A �d�C�c. ��dth-cam✓ O�/2��(� ��55 <br /> Send Lab Results to (Name): (Check Office Below) Verbals Requested: Yes ❑ No ❑ <br /> ❑ ATLANTA 1�1 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) 926-8651 TEL 1-5 f <br /> FAX (404) 956.9364 FAX (303) 799.0186 FAX(714)757-0960 FAX(415)960-0739 FAX (219) 926-7169 FAX �r <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- r- •-I ') WHITE:Field Copy YELLOW:Project Copy PINK:Laboramy Copy REV 8192 <br />