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; \ ! <br /> B PROJ <br /> CARONIE ENVIRONMENTAL L-HAIN-OF-CUSTODY RECORD 707 175 <br /> Reverse fly 'Instructions) NO. <br /> PROJECT NAME STK" S AXT A (-AOpt�.. ALtr (.(5E . <br /> SAMPLERS SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES v <br /> Q (PRINT) c DESCRIPTION CODES A. Ground Water F. Oil <br /> PROJECT NUMBER q -3;0q: 01 I Q ""'f -` L A. 40-ml VOA Vial B. SuAace Water G. waste i- Standard <br /> (SIGN) B. Glass Liter E. Brass Tube C. Leachate H. 81anIdSpike 2. 48 Hour, <br /> RECORDER C. Piastic 500-ml F.Other D- Rinseate I. Other - 3 24 Hour b <br /> (SIGN) - D. Plastic Liter. E. SoillSediment 4- Other - <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY , <br /> - CONTAINERS - o <br /> m g AND m <br /> gg PRESERVATION S <br /> x� <br /> 8 S8 � �_ SAMPLE <br /> Es _ $� NOTES ASSIGNED CONDITION <br /> DATE TIME SAMPLE Il] ; ~ E o BOTTLE UPON <br /> y = NUMBERS RECEIPT NOTES <br /> - <br /> 2. M <br /> 7Mzt7 100 \VJ- <br /> NOTES 1 MISCE NEOUS Relinquished by: (Signature) R eiveo By:'(Signature) Date Time <br /> Relinquished By: (Signature) Received By: (Signature) Date Time <br /> Relinquished By: (Signature) Rec Ived By: (Signature) Date Time <br /> Method of Shipment Description of Other Chains-Of-Custody Dispatched By: (Signature Date Time Rece)ved for la �: (Signature) Date Time <br /> . x Transport Container Transported with this F <br /> Chain (by Serial No.) f 070 �7 <br /> CWLE(L <br /> Send Lab Results to (Name): E 6 NN C-,. 5e (Check Office Below) Verbals Requeste es ❑ No ❑�: <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT, VIEW ❑ PORTER OTHERv <br /> TEL(404)951-0055 TEL(303) 790-1747 TEL (714) 757-1755 TEL(415) 960-1640 = TEL(219)926-8651 TE z1 <br /> FAX(404)956-9364 FAX (303) 799-0186 FAX (714) 757-0960 FAX(415) 960-0739 FAX(219) 926-7169 FAX z� <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(466) 586-9724 FAX(713) 556-0666 FAX(215)337-0560 FAX (510)`463-2981 FAX(503) 241-0486 FAX <br /> EANONIE ENVIRONMENTAL SERVICES, CORP. • 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 • TELEPHONE (303) 290-8336 • FAX (303) 290-8013 <br /> SERgkL NO. 1 n r; .A 0 WHITE:Fluid Copy YELLOW:Project Copy PINK:Laboratory Copy REV M2 <br />