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I <br /> CANONIE ENVIRONMENTAL OhAIN-OF-CUSTODY RECORD PROJECT <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME �►w�►ac e SAMPLERS T9M L_UArtM0'0 SA61PLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES , <br /> (P QES[,RIPT{ON CODES A Ground wafer F Oil <br /> PROJECT NUMBER �cw- r* - A 46-ml VOA Vial B Surface walar G waste I Slandard <br /> r <br /> B Glass 1-der E Brass Tuba C Leachate H Blank/Splka 2 48 Hour C <br /> RECORDER GC Plasllc SQfI ml F Other O Rmsaeie I Other 3 24 Hour <br /> (SIGN) <br /> D Plasllc Liter E SodlSedimenl 4 Other <br /> NUMBER OF ANALYSIS REQUESTED] LABORATORY USE ONLY <br /> ! CONTAINERS <br /> AND IAJ <br /> PRESERVATIONy q714 1 _H <br /> SAMPI E <br /> F <br /> NOTES ASSIGNED CONDITION <br /> BOTTLE UPON <br /> DATE TIME SAMPLE ID ' - a }- NUMBERS RECEIPT NOTES <br /> 5 - S'- <br /> D -SA-S s n X X <br /> Oy <br /> 64- 56 3 - ZA•O <br /> Z3 !JA- 583, 30 0 <br /> 2 6 - SA3 - <br /> o i A-58`1 -- s o <br /> W0� D- s$y - 30.o X XX <br />,) -s 5- S-4 <br /> VV <br /> NOTES MISCELLANEOUS ")It, G Jg4gSgp Relln lihed b lure) R eived By (Slgnature) Qa a Ttme <br /> ?"P1�� dT�X rMt9E ovw a+n¢��+,t O— �9,I fes" <br /> Relinquished B ( gna ure) R Ived By (Slgnature) D to Time <br /> l Relinquished By (Signature) Received By (Signature) Date Time <br /> Method of Shipment Description of 1 Other Chains Of Custody Dispatched By (Signature) Date Time Received for lab By (Signature) Date Time <br /> t� Transport Container Transported with this <br /> �'Yom- Chain (by Serial No Al <br /> 113 <br /> Send Lab Results to (Name) A14\A A- «o,M(+ (Check Office B ow) Verbals Requested Yes 11 No <br /> ❑ ATLANTA ❑ DENVER El IRVINE E:1 M1 VIEW El PORTER fit" OTHER <br /> TEL (404)9510056 TEL (303) 790 1747 TEL(714) 157 1755 TEL(415) 960 1640 TEL(219) 926 8651 TELA-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) 2410282 TEL <br /> FAX (406) 586-9724 FAX(713) 556-0666 FAX (215)337 0560 FAX(510) 463 2981 FA)f (503) 2410486 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP - 6300 SOUTH SYRACUSE WAY SUITE 300 - ENGLEWOQ , CO 80111 - TELEPHONE (303) 290-8338 - FAX (303) 290 8013 <br /> SERIAL NO 14683 WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV 8192 <br />