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PROJECT <br /> -- CANONIE ENVIRONMENTAL' AIN-OF-CUSTODY RECORD <br /> (See Reverse for Instructions) NO. <br /> PROJECT NAME 51 -1614 /Tit 6*6A: SAMPLERS Atm Flcomc5o SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PRIN�r DESCRIPTION CODES A. Ground water F. Oil <br /> PROJECT NUMBER _� � g Bl—�� A� t4A eJ A. 40-ml VOA Vial B. Surface water G. waste 1. standard <br /> (SIGN) B. Glass Liter E. Brass Tube C. Leachate H. BIanklSplke 2. 48 Hour <br /> RECORDER C. Plastic 500-ml F.Other D. Rinseate I. Other 3. 24 Hour <br /> (SIGN) D. Plastic Liter E. Soitisediment 4. Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> i AND a g <br /> :?g. PRESERVATION m —„m s` 1tl <br /> E.E¢ SAMPLE <br /> N"q5 NOTES ASSIGNED CONDITION <br /> DATE TIME SAMPLE ID N� V ~r s �~ BOTTLE UPON <br /> A NUMBERS RECEIPT NOTES <br /> I)22 1 130 ft vi-3 wekK 1r v <br /> 120 It/ ✓ <br /> NOTES 1 MISCELLANEOUS n Reiin uis !R7ec 'd by: (Signature} gnature) Date Time <br /> Relinquished By: (Signature) ived y: (Signature) Date Time <br /> �crll L>�g *CRaVAt. , ' <br /> Relinquished By: (Signature) Received By: (Signature) Date 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 /> /��,p y Chain (by Serial No.) <br /> tw <br /> Send Lab Results to (Name): = (Check Office Below) Verbals Requested: Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT. VIEW ❑ PORTER EXTHER AldbeS7811 <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 �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 /> SERIAL NO. 14592 WHITE:Field Copy YELLOW:Project Copy PINK:Laboratory Copy REV.W92 <br />