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1+1C_A,t 0J9,GS7_0 <br /> i O"CIME-ENVIRONMENTAL CIN-OF-CUSTODY RECORD PROJECT <br /> f (See Reverse fa structlions) NO 1 P 1 <br /> ( 14 <br /> PROJECT NAME ��na �>,1�'n�c,� - XA SAMPLERS Tom^ LQ "' -- SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> ZS (PR1_N,TI DESCRIPTION CODES A Ground Water F Oil <br /> PROJECT NUMBER 1, r�A Com` — — A 40,ml VOA Vial B Surface Water G Waste 1 Standard <br /> (SIGN) B Glass biter E Brass Ty e C Leachate H BlanklSpike 2 48 HDLr <br /> RECORDER � C Plastic 500 ml F Others! D Rlnseate I Other 3 24 Hour <br /> (SIGN) D Plas4c Wer 4 £ s-11sediment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND <br /> a—. PRESERVATEON B C8 $a 8 6 a <br /> F — g� a SAMPLE <br /> E "�aU NOTES ASSIGNED CONDITION <br /> > BOTTLE UPON <br /> DATE TIME SAMPLE ID � m _ ~ H z NUMBERS RECEIPT NOTES <br /> 0 (_(x—S81— 15 11 1 1 1 y xti <br /> Cq Z9 C 6- -Z <br /> 0 - S 30 <br /> z 5 <br /> 13y 3 - 5 <br /> 3-7 - s - 10 <br /> )1105 ff,_ -S.6-1 - IS <br /> 52 . -25 <br /> r <br /> NOTE51 MISCELLANEOUS,* 44_ Reh uished by (Signature) Receiv d By $ na ure}/,- Date Time <br /> 11 <br /> M%8 J0 f PC TAME, _IZn1 Fr615. �Rehhgqtfished <br /> tBy�(rStgnature) <br /> re) eceived By (Signature) ate Time <br /> /� <br /> Received By (5 gnature) ate Time <br /> C� �S 930 end L�'. r��Al <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 (by Serial No) <br /> CmA R-,-r l �$ <br /> Send Lab Results to (Name) P- Q� <br /> ( } (Check Office Below) Verbals Requested Yes ❑ No <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER � OTHER MOJ�10 <br /> TEL (404) 951-0055 TEL(303) 790-1747 TEL(714) 757-1755 TEL(415) 960 1640 TEL(219) 926-8651 TELZIJ`i 2_+ -?- I <br /> h FAX(4D4) 956-9364 FAX(303)799 0186 FAX(7114) 757-0960 FAX{415) 960 0739 FAX (219) 926-7169 FAXZ 09 '5_+9 I-2 2s <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 a ENGLEWOOD, CO 80111 • TELEPHONE 303) 290-8336 • FAX (303) 290-8013 <br /> SERIAL NO 14 G � 8 WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV 6192 <br />