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N RECORD OMPROJECT <br /> CANONIE ENVIRONMENTAL NAIM-OF-CUSTODY <br /> ,r (See Reverse for Instructions) NO <br /> YV <br /> PROJECT NAME 61 �A try _ SAMPLERS UlflklA4k SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> r RIN DESCRIPTION CODES A Ground Water F oil <br /> PROJECT NUMBER `U A 40-ml VOA Vial B Surface water a Waste 1 Standard <br /> (Slat) B Glass Liter E Brass Tube C Leachale H Blank/Spike 2 48 Hour <br /> RECORDER 1 ` C Plastic 500-mi F Other D Rinseate I Other 3 24 Hour <br /> (SIGN) D Plastic Liter E Soil/Sediment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND <br /> -- PRESERVATION $Y k <br /> Dais s� 7 _ SAMPLE <br /> NOTES ASSIGNED CONDITION <br /> BOTTLE UPON <br /> DATE TIME SAMPLE ID � _ NUMBERS RECEIPT NOTES <br /> a�o�! <br /> AA <br /> -I- 1h a 6 <br /> ow8 <br /> LISD <br /> —2-- ,5 210 <br /> --Z— 05/ <br /> W-2 06A <br /> MW-3 - 05 " <br /> /bcw-3— 6.0 vs� <br /> AAW-3— !W: 065 <br /> NOTES!MISCELLANEOIUSl. y eltnq ed by nature) at ad By Sign ture) Date Time <br /> of� t 65 � �jd ��r �S ��l� nd �-�� Relinquished By (Signature) Received-By (Signature) �� Date Time <br /> 7rza LA the <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> Method of Shipment Description of Other Chains-Of-Custody Dtapatched By (Signature) Date Time Received for lab By (Signature) Date Time <br /> Transport Container Transported with this <br /> Chain (by Seri�S �o) <br /> _ <br /> -CoV(Lit (�p, 7�� 5- <br /> Send Lab Results to (Name) (Check Office Below) Verbals Requested Yes EfNo ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER ff'OTHE WS6 <br /> TEL(404)951-0055 TEL(303) 790.1747 TEL(714) 757-1755 TEL(415)960.1640 TEL(219)926.8651 TEL;1 x'22- 1 <br /> FAX(404)956-9364 FAX(303) 799-0186 FAX(714) 757-0960 FAX(415}980 0739 FAX(219) 926-7169 << ' FAX `Z ZZ <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)556-0666 FAX(215)337-0560 FAX(510)463.2981 FAX (503)241-0486 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP - 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 - TELEPHONE '303 290-8336 - FAX 303) 290-8013 <br /> SERIAL NO _155 �8 WHITE Recd Copy YELLOW Protect Copy PINK Laboratory Copy REV 8192 <br />