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r <br /> CANONIE ENVIRONMENTACHAIN-OF-CUSTODY RECORD <br /> LAB A?'(See Reverse for Instructions) NO <br /> A '��} '; <br /> PROJECT NAME V 1J S pG i 0 SAMPLERS tg l.D(LE 5 SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PRINT DESCRIPTION CODES A Ground waler F Oil <br /> PROJECT NUMBER ' _ !7 12, <br /> A 40-m1 VOA Via! B Surface Waler G Waste t Slendard 1„ <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H Blank/Spike 2 48 Hour ) <br /> RECORDER C Plastic 500 m! F 011ier D glneeate 1 Olhar 3 21 Hou <br /> (SIGN) D Plastic Liter E Soll/Sedimanl 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERSER� <br /> PRESERVATION 'a <br /> 11 <br /> _ °Cf 11 NOTES ASSIGNED CONDITION q502-361DATE TIME SAMPLE ID ~v � BOTTLE UPON <br /> ;= NUMBERS RECEIPT NOTES <br /> GS -I A 1A 3 1/1 1 1 1 ) 1 <br /> ✓ I I_ I <br /> 1110 S tAW-13h tI 1_ ✓ ✓ 7 <br /> 55 C.S -rD <br /> A �- 1 ✓ ,, --- <br /> 6 0 -t t 07 ✓ r r <br /> I t 1k hkW- Ar ✓ 1 ✓ r <br /> o w� - <br /> I I F <br /> �- ) r r <br /> NOTES/MISCELLAN EOU S Ralinyuished by (Signature) Re elved By (Si. n re) Date Time <br /> t-r`8' YlIK- 1` ,m <br /> S?4VO lA At JALrq'ri"L. Relinqu shed By (Signaturgj9, Received By ( gnature) Date <br /> �� <br /> Rellnq ished By (Slgnature) Received By (Signa Date Tlme <br /> Method of Shipment Description of Other Chains-01-Custody Dispatched By (Signature) Time ceived for lab By (Signature) Date Time <br /> Transport Container Transported with this <br /> l <br /> KA e- Chain(by Serial No) <br /> AU R l E 1L R. 2 41216�Z� IV, �7-46' c�KDa _ <br /> Send Lab Results to (Name) - - - (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ DALLAS ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER HER r-i <br /> TEL(214) 770-1800 TEL(303) 790.1747 TEL(714)757-1755 TEL (415) 960 1640 TEL (219) 926 8651 TEL ',S S07 <br /> FAX(214)770 0249 FAX (303) 799-0186 FAX(714)757 0960 FAX (415)960-0739 FAX (219)926 7169 FAX S ' ,a <br /> „ ❑ 13OZEMAN ❑ HOUSTON ❑ KIN13 OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER <br /> ( TEL(406) 586 9496 TEL(713) 589 8686 TEL(215)337 2551 TEL (510) 463 9117 TEL(503) 2410282 TEL <br /> FAX (406)586 9724 FAX(713) 531-8886 FAX(215)337-0560 FAX (510) 463 2981 FAX (503) 2410486 FAX __ <br /> ONiE ENVIRONMENTAL SERVICES, CORP a TWO GALLERIA TOWER a 13455 NOEL ROAD, SUITE 1500 a DALLAS, TX 75240 a TELEPHONE (214) 770 1800 a FAX (214 770 0249 <br /> 7 A 1 q9 WHITE Field Copy YELLOW Prolacl Copy PINK Labowory Cup, --- <br /> ( rn <br />