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CANONIE ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LAB PR046CT <br /> AAmoi^ (See Reverse for Instructions) NO. �' <br /> PROJECT NAME _YLsc.��'M�r Q«Q���� SAMPLERS XYZ ''���'�^'ti`�r' SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES *Ir <br /> INTI DESCRIPTION CODES A. Ground Water F. Oil <br /> PROJECT NUMBER 9 S-I(Z TASy. _ y Q ,w. A 40 m!YOA vial a. surleco water G. wase 1. Slandard <br /> ( 0. Glass Liter E. Brassube C. Leachate H. Blank/Spike 2. 48 How <br /> RECORDER - C. Plastic 500-ml F. her D. Rlnseale I. Other 3. 24 Hour <br /> (SIGN) D. Plastic Liter E. SotUSedlmant 4. Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> g AND <br /> 1Ta^g PRESERVATION _ 1i_ 1} a <br /> I 8 LE ^ SAMPLE <br /> It — NOTES ASSIGNED CONDITION <br /> it i` BOTTLE UPON <br /> DATE TIME SAMPLE ID r NUMBERS RECEIPT NOTES <br /> .Sj( ► I xyl I I1 <br /> a % to' —Sg 1 F 1V Stl I I I hlSn 2 - <br /> {a <br /> -kLAL hip— <br /> NOTES!MISCELLANEOUS Relinquished by: (Signature} Received By: (Signature) Data Time <br /> r 16'00 <br /> Relinquished By: (Signature) Received By: (Signature) Dale Time <br /> Relinquished By: (Signature) Received By: (Signature) -6a--ie 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 /> Chain(by Serial No.) <br /> Send Lab Results to (Name): _ J��^�n �-�^� -__._—..___ (Check Office Below) Verbals Requested: Yes NO ❑ <br /> ❑ DALLAS ❑ DENVER ❑ IRVINE ❑ MT. VIEW ❑ PORTER OTHERic,lc�-. <br /> TEL(214) 770-1800 TEL(303) 790-1747 TEL(714) 757-1755 TEL(415)960.1640 TEL(219) 926.8651 TEL ?rA ^3 0-1 <br /> FAX(214) 770-0249 FAX (303) 799.0186 FAX(714) 757-0960 FAX(415)960-0739 FAX(219)928.7169FAX z. S' %Cfj <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER <br /> TEL(406)586-9496 TEL(713)589.8686 TEL(215)337.2551: TEL(510)463-9117 TEL(503) 241.0282 TEL <br /> FAX (406)586-9724 FAX(713)531-8888 FAX(215)337-0560 FAX(510)483.2981 FAX(503) 241.0486 FAX _ <br /> CANONIE ENVIRONMENTAL SERVICES, CORP. • TWO GALLERIA TOWER - 13455 NOEL ROAD, SUITE 1500 • DALLAS, TX 75240 • TELEPHONE (214) 770.1800 - FAX(214) 770-0249 <br /> SERIAL NO. f} 0 1 n WHITE:Field Copy YELLOW:Pro*I Copy PINK:Laboratory Copy HFV iiNj <br />