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�✓ a v <br /> CANONIE ENVIRONMENTAL AIN--OF-CUSTODY RECORD � PROJECT <br /> �j—A (See Reverse toff instructions) NO_ <br /> PROJECT NAME ���J`lOS"' ` � SAMPLERS TQM LJ t+�� �-- SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> �-.�4� (PRIN DESCRIPTION CODES A Ground water F Oil <br /> PROJECT NUMBER c r A 40-nil VOA Vial B Surface Water G Waste s Standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H BlanklSprke 2 48 Hour <br /> RECORDER D V 4r C Plastic 50o-mt F Other D Rmseate I Other 3 24 Hour <br /> (SIGN) D Plastic Liter E $ad/Sedimani 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS u <br /> g AND 8 aY <br /> wg—g Fig^ PRESERVATION <br /> H <br /> _7f <br /> I? _ SAMPLE <br /> a a€ _ � NOTES ASSIGNED CONDITION <br /> DATE TIME SAMPLE ID .T 3p Z BOTTLE UPON <br /> }�- NUMBERS RECEIPT NOTES <br /> d]p (- t <br /> yl to (G• s8 VJ D - <br /> ta -s83-u1 3 <br /> s c Sill _E ! 3 <br /> !44 t cr' 5 85-W a5A- k k <br /> 435 <br /> NOTES/MISCELLANEOUS {� �� >t 4���>�� � �� Rcashed by (Signature) Reeeiv Sy i ure Date Time <br /> Mak.461 AE , 714ME, 779 elln Inc= <br /> Zmq (Sf re) Regeived y Signature) /D to Tlme <br /> Rehn$u--ished By (Signature) Receiv d By (Signature) Date Time <br /> Method of Shipment Description 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 /> Send Lab Results to (Name) � �' (Check Office Below) Verbals Requested Yes ❑,�No <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER OTHERS <br /> TEL (404) 951-0055 TEL (303) 790-1747 TEL(714) 7571755 TEL(415)960-1640 TEL(219)9268651 TELA ` 't I <br /> FAX(404)956 9364 FAX(303)799-0186 FAX(714)757-0960 FAX (415)960-0739 FAX(219) 926-7169 FAX "-VO-1 <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 1303) 290-8336 • FAX (303) 290-8013 <br /> SERIAL NOA A WHITE Field Copy YELLOW Project Copy PINK LaWratory Copy REV 1352t 4 <br />