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i CANONIE ENVIRONMENTAL&AIN-OF-CUSTODY RECORD B PROJECT <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME QY] klitI` ;Pt% Cr0`0"'^ SAMPLERS TWA tLj""_' `— SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> -� (PR DESCRIPTION CODES A Ground water F Oil <br /> PROJECT NUMBER l {� — <br /> a�•-. A 40 ml VOA Vial B Surface water G waste i Standard <br /> %i �/y�/k p (SIGN) B Glass Liter E Brass Tuba C LeacRinse ate I thenBlanSpike 2 24 Hour <br /> RECORDER JT "L` C PlesLc 500-m1 F Other D Rmseate I Other 3 2a Hour <br /> (SIGN) D Plastic Liter E Sod/Sediment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> "¢ AND + <br /> as Sg PRESERVATION 3 ° _ <br /> $ s§ - xY SAMPLE <br /> $m $ i ¢� ' `o NOTES ASSIGNED CONDITION <br /> E_ @ x n ? BOTTLE UPON <br /> DATE TIME SAMPLE ID Z NUMBERS RECEIPT NOTES <br /> zn 1 X <br /> 1a6 C G-SA 3-VJ A 3 kly <br /> Ic{s C(-- SA 4-W 3 YY V X <br /> 1140 Cc><- 5135— 3 <br /> t3a� CC"- Sbb- WilliIA X <br /> Ah1!k <br /> NOTES/MISCELLANEOUS �'(p C - � v.l� V' Rel ulshed by (Signature) Receiv By lg re Date Time <br /> �M��6 f b r AF,nom, 744 , FaE l �.,�.., � l0 1 S <br /> Relinquished By (Signature) Rec lived y Ignature) ate Time <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> i: 4EAl <br /> Method of Shipment Descnption 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 <br /> fChaiinnr(by Serial No) <br /> (tokQ, -7�0� <br /> Send Lab Results to (Name) a� (Check Office Below) Verbals Requested Yes J❑ No <br /> El ATLANTA ❑ DENVER ❑ IRVINE El MT VIEW El PORTER �€ OTHER <br /> TEL(404) 951-0055 TEL(303) 790-1747 TEL(714)7571755 TEL(415) 960-1640 TEL(219)926-8651 TELX( <br /> FAX(404)956-9364 FAX(303) 799-0186 FAX(714)757 0960 FAX(415) 960-0739 FAX(219) 926-7169 FAX Uff <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) 2410262 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 14689 W141TE Field Copy YELLOW Prciod Copy PINK Laboratory Copy REV 6192 <br />