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', LAB PROJECT <br /> CANONIE ENVIRONMEI� L CHAIN-OF-CUSTODY RECONR+ D <br /> t II _(See Reverse for Instructions) 9 �,v, NO. <br /> PROJECT HA E S/� t m^ � �. '�^ -� SAMPLERS; !�NTH tea_-7 SS�i,vy - '— <br /> SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> PROJE=CT NUMBER3 9 G! - 1 U '"n s DESCRIPTION CODES A. Ground Weler F. Gu <br /> f�w�.. Al• 40-ml VOA Vial e. Surface Water G. Waste 1. Slandard <br /> (SIGN) B. Glass Liter E. Brave Tube C. Leachale H. elankiSplke 2. 4B Hour <br /> RECORDER C. Plastic 5Mml F.Other O. Rlnseate L Other 3. 24 Hour <br /> (SIGN) O. Plastic Liter E. SoillSedlmenl _ 4. Other <br /> NUMBER.OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND <br /> PRESERVATION Q 5 # a ^ <br /> SAMPLE <br /> _ , � - NOTES ASSIGNED CONDITION <br /> DATE TIME SAMPLE ID ~ = BOTTLE UPON <br /> uo39V 1 S- C ,v,w - A yr <br /> NUMBERS RECEIPT NOTES <br /> 1 r,ulgr 1a.1 S C M W <br /> �79T /luu C ,A w • A x ? <br /> � V <br /> —7:ffi <br /> NOTES/MISCELLANEOUS Relinquished by: (Signature) d B Signature) to Time <br /> 267 <br /> Rellnquls ed By: (Signature) Received By: (Signature) Dale Tlme <br /> Relinquished By: <br /> (Signature) Received By; (Signature) Date Time <br /> Method GI Shipment Descrlpllon of Other Chainp-Of-Custody Dispatched By, (Signature) Date Time Received for lab By: (Signature) Date Tlme <br /> S' Transport Container" Transported with INS <br /> Chain {by Serial No.) y/ S"� � U 0 Gq, <br /> Send Lab Results to (Name); Ja'.r `i1 ' / /0 M414— aT (Check Office Below) Verbals Requested: Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ 'DENVER ❑ IRVINE ❑ MT. VIEW ❑ PORTER LSY OTHER 1120-1[41' <br /> TEL (404) 951.0055 TEL(303)790.1747TEL(714)757-1755 TEL(415)960-1640 TEL(219) 926-8651 TEL 7rr <br /> FAX (404) 956-9364 FAX(303)799-0186 . I FAX(714)757-0960 FAX (415)960-0739 FAX(219) 926.7169 FAX $ �r <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KINGOF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER <br /> TEL(406) 686-9496 TEL(713)556.1865 TEL(215)337-2551 TEL(510) 463.9117 TEL(503)241.0262 TEL <br /> FAX(406) 586-9724 FAX(713)556-0668 FAX (215)337-0560 FAX(510) 463-2981 FAX (503) 241-0486 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP • 8300 SOUTH SYRACUSE WAY, SUITE 300 a ENGLEWOOD, CO 80111 • TELEPHONE 303 290-8336 • FAX 308 290-8013 <br /> SERIAL NO. �1 (:- ►"` f� + WHITE'Field Copy YELLOW:Project CnpV PINK-I ahnrelnr Cn <br /> 1 1 lV PV ill"+J Hrr- <br />