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CANONIE ENVIRONMENTAL" HAIN-OF-CUSTODY RFCQRD PROJECT <br /> (See Reverse for Instructions) NO. <br /> PROJECT NAME�g^ Y1�1��/ ad1.4 jw SAMPLERS F SAMPLE CONTAINER: SAMPLE DESCRIPTION CODES TAT CODES <br /> (PRIN� DESCRIPTION CODES A. Ground Water F. Oit - <br /> PROJECT NUMBER q!q—�, 74 per/ A. 40-ml VOA Vial B. Surface Water G. waste 1. Standard f' <br /> (SIGN) B. Glass Liter E. Brass Tube - C. Leachate H. BlanldSpike _2. 48 Hour i <br /> RECORDER C. Plastic Soo-ml F.Other D. Rinseate I. Other 3. 24 Hour <br /> (SIGN) D. Plastic Liter E. Soll7Sediment 4. Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY . <br /> CONTAINERS <br /> AND 8 e g <br /> A^m dm PRESERVATION 'Z H m $ <br /> �$ �`tn'8 'ut i <br /> 3� �t e E _� SAMPLE <br /> a� s Z m`-' �m a`2 7 <br /> m°a� NOTES ASSIGNED CONDITION <br /> DATE TIME SAMPLE ID Nm LL o BOTTLE UPON <br /> pp NUMBERS RECEIPT NOTES <br /> f ` <br /> A ✓ 7- <br /> NOTES I MISCELLANEOUS <br /> - <br /> NOTESIMISCELLANEOUS Relinquished by: (Signature) Racal gnature) Date Time <br /> ;AM9L- ~ ,TE �� TUB y: (gnature) ived y. (Signature) Date Time <br /> t- elinquis ed By: (Signature) Received By: (Signature) Date Time <br /> Method of Shipment Description of Other Chains-Of-Custody Dispatched By: (Signature) Date Time Rec ived for lab By: (Signature) Date Time <br /> Transport Container Transported with this <br /> ` Chain (by <br /> ySerial No.) ( 9 <br /> to <br /> Send Lab Results to (Name): G 9AIA4 Se V (Cheek Office Belo VerbalsRequested: Yes-�<.NO" ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT. VIEW ❑ PORTER OTHER 41QbF-<3Z <br /> TEL(404) 951-0055 TEL (303) 790-1747 TEL (714) 757-1755 TEL(415) 960-1640 TEL(219) 926-8651 TEL - Z� <br /> FAX(404) 956-9364 . FAX(303) 799-0186 FAX (714) 757-0960 FAX (415) 960-0739 FAX (219) 926-7169 FAX <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) 29041316 • FAX t3011 PCIn-An11 <br /> F <br />