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CANONIE ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LAB PROJECT <br /> / 1 751 <br /> '1 M I\ n ( (See 'p�/Jeverse for Instructions) "1 7 P- .3 G NO. YP98" " <br /> PROJECT NAME �I f k �� �11�\O� ' I,L�t0 SAMPLERSCV � P,t li tlSAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PRI DESCRIPTION CODES A. Ground water F. Oil <br /> PROJECT NUMBER J G� raP,, I A. 40-m1 VOA Vial B. Surface water G. Waste t. Standard <br /> (SIGN) B. Glass Liter E. Brass Tube C. Leachate H. Blank/Spike 2. 48 Hour <br /> 1 RECORDER C. Plastic 500-m1 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 n <br /> AND <br /> .PRESERVATION m t") „m a 4 a <br /> ?E �y m0 <br /> G J O SAMPLE m` e J �� ¢° E1. m°<8 NOTES ASSIGNED CONDITION <br /> z <br /> E a = `f LL z �- E E ° BOTTLE UPON <br /> DATE TIME SAMPLE ID D N y z NUMBERS RECEIPT NOTES <br /> ib 14'.1 -) ri., e t L- <br /> o <br /> NOTES/MISCELLANEOUS elinquis ed by: (Signature) R9c 'v d By:.($ign re ///-�DTTe Time <br /> SH'ftl, CQ(Va� �vV,� Sty+(o>v i //, % C lllz, (�\ (�E:(( ` ��' �J <br /> Relinquished By: (Signature) Received By: (Signature) Date Time <br /> � <br /> r Relinquished By: (Signature) Received By: (Signature) Date Time ho� <br /> Method of Shipment Description of Other Chains-Of-Custody Dispatched By: (Signature) Date Time Received for lab By: (Signature) Date Time <br /> n t Transport Container Transported with this <br /> I\ pol CChain (by Serial No.) <br /> Send Lab Results to (Name): o^j f o i+-` ocki 14,010 (Check Office Below) Ver Is Requested: Yes ❑ No ❑ <br /> ❑ PORTER ❑ SAN MATEO ❑ 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)573-5654 FAX(714) 757.0960 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) 556.0666 FAX(415)960-0739 FAX <br /> CANONIE ENVIRONMENTAL LABORATORY • 212 FRANK WEST CIRCLE, SUITE A • STOCKTON, CA 95206• TEL.(209) 983-1340 • FAX (209) 983-0304 <br /> SERIAL NO. U 1 Z U b. I WHITE:Field Copy YELLOW:Project Copy PINK:Laboratory Copy <br />