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CANONIE ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LAB Q1jo,k,, , <br /> M l (Seel errerse for Instructions) NO. � <br /> PROJECT NAME q+-,%- SAMPLERS <br /> ' ` �� . �,.>�t� SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES ' <br /> {pRIN DESCRIPTION CODES A. Ground water F. oil ,//�� <br /> PROJECT NUMBER 40 ml VOA Via 8.B. Surtace Water G. Walla ( rslandard <br /> (SIGN) B. Glass Liter l )Brass Tube C. Leachate H. elanWSpike 2. 48 Hour <br /> RECORDER C. Plasllc 5DO-mi F,Other 0. Rinseate f. Olhdt- 3. 24 Hour <br /> (SIGN) D. plastic Liter _ SoiVSedimant __._.—_— 4. Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> V <br /> AND S <br /> aa— PRESERVATION B Sg <br /> SAMPLE <br /> NOTES ASSIGNED CONDITION <br /> DATE TBOTTLE UPON <br /> TIME SAMPLE ID z` NUMBERS RECEIPT NOTES <br /> t 3� 3 50 )C .::%i 11 h Ic"9 C <br /> NOTE !MISCELLANEOUS y <br /> Relinquished hy: (S' not e' : ( ' nal hr5 <br /> 11633 • M� "�f �I l:a ' ate-} o �( (1 J / ,� , Time . <br /> �., 3 <br /> 00 5 Win,9 LoRelinquished By: (Signature) Received By. (Signature) Date Time <br /> Relinquished By: (Signature) Received By: (Signature) Date' Time <br /> Method of Shipment Description of Other Chains-Of-Custody Dispatched By:(Signature) Dale Time Received for lab By: (Signature) Data Time <br /> Transpolt Container Transported with this <br /> Chain'-(by Serial Nii.) / <br /> Send Lab Results to (Name): &AxAj SAitt AW7(Check Office Below) Verbals Requested: Yes ❑ No ❑ <br /> PORTER ❑ SAN MATED ❑ IRVINE ❑ ORLANDO ❑ OTHER <br /> TEL(219)926-8651 TEL(415)573-8012 TEL(714)757-1755 TEL(407)856-7428 TEL <br /> FAX(219)926.7169 FAX(415)5735554 FAX(714)767-0960 FAX(407)855-2595 FAX <br /> ❑ DENVER ❑ KING OF PRUSSIA ❑ HOUSTON ❑ MT. VIEW ❑ OTHER <br /> TEL(303)790.1747 TEL(215)337-2551 TEL(713)556-1666 TEL(415)960-1640 TEL <br /> FAX(303)799-0186 FAX(215)337-0560 FAX(713)556-0666FAX (415)960-0739 FAX <br /> CA <br /> NONIE ENVIRONMENTAL LABORATORY• 212 FRANK WEST CIRCLE, SUITE A • STOCKTON, CA 95206 • TEL. 209 983-1340 • FAX X09) 963-0304 <br /> SERIAL NO. 07700 WHITE:Field Copy YELLOW:Project Copy PINK:Laboralory Copy <br />