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CANONIE ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LAB PROJECT <br /> (See Reverse for Instructions) NO <br /> uTCY-Too -iW N (A Ww pt t.c <br /> PROJECT NAME SAMPLERS SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> IPgINT)^'� DESCRIPTION CODES A. Ground Water F. Oil <br /> �'4J ��t"�'—� L' A. 40 mI VOA Vial B. Surface Water G. Waste 1. Standard <br /> PROJECT NUMBER '11'I ' yl ���(� 2 J <br /> (SIGN) B. Glass Lila, E. Brass Tube C. Leachate H. BlanWSpike 2. 48 Hour <br /> RECORDER c Plastic 500 un F.Omer O. Rin seato 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 /> I�O I�I��-- AND <br /> PRESERVATION $ P $ q <br /> PRESERVATION <br /> 3E§ LL< b ? av Ella E�=� SAMPLE <br /> 716 �t <br /> - aNOTES ASSIGNED CONDITION <br /> E BOTTLE UPON <br /> DATE TIME SAMPLE ID .. NUMBERS RECEIPT NOTES <br /> anilgio M Nt I. A 2, L t ✓ t f U D <br /> =q uW 2 z ✓ ✓ 1 v Dz <br /> Zti f $ M tiV- d t V ✓ 03 <br /> 1 <br /> -------------- <br /> # I I <br /> I <br /> r <br /> NOTES I MISCELLANEOUS r �"�r {� EC0124 JAS{fj!%( - Relinquished by: (Signature) Reg ived : (�Wnalyree Date Time <br /> Lar,: Se4,�ol -FC, _ y + �e `1 -I2s y. 9 `f0 <br /> �F�yE'2r1 !tJ/Z,6� (/�� V Relinquished By: (Signature) Received By: (Signature) Date Time <br /> GAIo • �ru-iva� , f <br /> Relinquished By: (Signature) Received By: (Signature) Data Time <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 /> Chain (by Serial No.) <br /> �Oo1. 'e NIS ,96 zs— 1030 <br /> Send Lab Results to (Name): EfNNE d�+/SE (Check Office Below) Verbals Requeste : Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT. VIEW ❑ PORTER OTHER. III1013 SFO <br /> TEL(404) 951-0055 TEL(303)790-1747 TEL(714) 757-1755 TEL(415)960-1640 TEL(219) 926-8651 TEL <br /> FAX(404) 956-9364 FAX(303) 799-0186 FAX(714) 757-0960 FAX (415) 960.0739 FAX (219)926-7169 FAX OZZL-S <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 /> a . L NO. !r (� t— q WHITE.F Id C py YELLOW:Project Copy PINK:Laboratory Copy REV 8/82 <br /> ! I Y <br />