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CANONIE ENVIRONMENTAL 'Z 4AIN-OF-CUSTODY RECORD PROJECT <br /> �. <br /> (See Reverse for Instructions) NOES .. <br /> PROJECT NAME CVl t'11 t1 (/a"A I'--- SAMPLERS Ttof7 S SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> _ n (Pp INT) DESCRIPTION CODES A. Ground Water F. Oil <br /> PROJECT NUMBER q 1A- �G,9 C�I ` ((] 'A t� A. 40-m1 VOA Vial G. surface water G. waste 1. Standard <br /> (SIGN) B. Glass Liter E. Blrass Tube C. Leachate H. Blank/Spike 2. 46 Hour <br /> RECORDER C. Plastic 500-m1 F.Other D. Rlnseate I. Other 3. 24 Hour <br /> (SIGN) D. Plasl[C Liter E. Soll/Sedlment 4, Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> 5AND DO �S �'m $m PRESERVATION $ _Is � <br /> T <br /> � ,eE HV6E E- SAMPLE <br /> NOTES ASSIGNED &ONDTON <br /> E _ E BOTTLE UPON <br /> DATE TIME SAMPLE ID ~N z _ NUMBERS RECEIPT NOTES <br /> rJLF34f l3n0 Mw� 1 t/ L- o, ✓ <br /> n '� 1310 rJ-2 ✓ ✓ 41v az <br /> (y ,09 1325 1r� 8 ✓ ✓ I ✓ ,/ b <br /> 043096 12'40 M -5 H r v ( t/ ✓ <br /> 1260 16 v LlI ✓ <br /> NOTES MISCELLANEOUS F� AS� FoR , Relinqulshr edgy: (SignatulB) Rgpelved By: (Signature} Dats Time <br /> �P 01APLt <br /> Lrg3: &Q001A VraIQ <br /> '� i4 Tv r�� Relinquished By: (Signature) ReceivQg By <br /> (Signature) Dale Time <br /> A )Z r z V <br /> Relin ujsh'ed By: (Signature) ReceiBy: (Signature) Date Time <br /> Method of Shipment Description of Other Chains-Of-Cuslody Dispatched By: (Signature) Date Time' Recei d for lab By: ature) Date Time <br /> VLTi2A Transport Container Transported with this q t <br /> Chain (by Serial No.) <br /> .-050j-S2—: <br /> Send Lab Results to (Name): Iq NNS domaw (Check Mice Below) Verbals Requested: Yes No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT. VIEW ❑ PORTER OTHER 1 0Dt;5;rf: <br /> TEL(404) 951.0055 TEL(303) 790-.1747_ TEL(714) 757-1755 TEL(415)950.1640 TEL(219) 926-8651 TEL <br /> FAX (404)956-9364 FAX(303) 799-0186. FAX (714) 757-0950 FAX:(415) 960.0739 FAX(219) 92&-7169 FAX 7-0 577 17 <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).556-066 FAX(215) 337-0560 FAX(510)483-2981 FAX (503)241.0486 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP. • 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 a TELEPHONE (303) 290-8336 • FAX (303 290-8013 <br /> SERIAL NO. 4" rr WHITE:Field Copy YELLOW:Project Copy PINK:Laboratory Copy REV 6f92 <br /> 1a � r . <br />