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CANONIE ENVIRONMENTAL �HAIN-OF-CUSTODY RECORD LAB•PROJECI <br /> Ir (See Rever t; for Instructions) �. <br /> PROJECT NAME C"Loqr: 2 f 1zUPt T� tl �1 I <br /> ' SAMPLERS `1`tk t t.pi(�C S SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> q !T t <br /> (PRI T) J DESCRIPTION CODES A. Ground Water F. Oil <br /> PROJECT NUMBER 15� 2 " ' b ' t �� A. 40-ml VOA Vial 8. Surface Water G. Waste 1. Standard <br /> (SIGN) B. Glass Liter E. Brass Tuba C. Leachate H. Blank/Splke 2. 48 Hour <br /> RECORDER '�' r, r` C. Plastic 51H)ml F.Other D. Rinseate I. Other 3. 24 Hour <br /> (SIGN) D. Plastic Liter E. Soll/Sedlment _ 4. Other <br /> c NUMBER OF ALYSIS REQUESTED LABORATORY USE ONLY <br /> • t l� i CONTAINERS <br /> AND <br /> ,11 $ a PRESERVATION $ I'^ 8_gg tit <br /> $ $ 48 $xY SAMPLE <br /> NOTES ASSIGNBOTTLED COUPON N <br /> DATE TIME SAMPLE ID, �. , ° NUMBERS RECEIPT NOTES <br /> a <br /> A A.t ✓ I - — <br /> T1--25z% to 3 t <br /> NOTES/MISPYa <br /> LANEOUS >a�>� (20V'!,1�E Cop\C'S el' had gnatur Received By: (Signature1_ Date Time <br /> C)Y\ (,V,O M A'(0'Ca.2AMS, (!)f <br /> � ` YRelinquished By: (Signature) Received By: (Signature) Date TY <br /> ij +. 'l <br /> p Relinquished By: (Signature) Received By: (Signature) Date Time <br /> ; ., .Pp '.for BTE?`• <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 /> C ,aaiin`((bby?Seri I No.) <br /> 1C 1 ^.V0 �-'� �✓'/,,�7 ii <br /> Send Lab Results toName : l Lr I'A tom' ;_ : , <br /> ( ) t (Check Office Below) Verbais Requested: Yes ❑ No ❑ <br /> ❑ ATLANTA (� DENVER 3 i`: IRVINE I' <br /> w .I� ❑ MT. VIEW ❑ PORTER OTHER <br /> TEL(404)951.0055 TEL(303) 790-117471; ".' ;' f. '� �, TEL(714)''757-1755 TEL(415)960-1640 TEL (219) 926 8651 TEL` L <br /> FAX(404)956.9364 FAX'(303) 799 0168, " FAX{714)757-0960• FAX(415)960-0739 FAX (219) 926-7169 FAX <br /> ❑ BOZEMAN ❑ HOUSTON r, " , °' ,�, ;�&6 OF.PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER <br /> TEL(406) 586.9496 TEL(713) 556-1866,-.1 a�": ', ~. TEL(215)337-2551 TEL(510)463-9117 TEL (503) 241-0282 TEL <br /> FAX(406)586-9724FAX (713) 556.08861 0u �' ;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 <br /> C 7 1 tZ WHITE:Field Copy YELLOW:Project Copy PINK:Laboratory Copy REV.8/92 <br />