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C, A rc P, eS ENVIRONMENTAAHAIN-OF-CUSTODY RECORD 49AB PROJECT <br /> `_ Q (See Reverse for Instructions) NO <br /> PROJECT NAME TQ AA EIS. PEATY SAMPLERS ` 'LFIIL O'-C� SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (02 Sq ff __ii (PRINT) DESCRIPTION CODES A Ground water F on <br /> PROJECT NUMBER rp,OqO, d, 7� A 40-m1 VOA Vial B Surface water G wastetanda,, <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H Blank/Spike 2 48 Hour <br /> RECORDER C Plastic 500-m1 F Other D Ainseate I Other 3 24 Hour <br /> (SIGN) D Plastic Liter E SoillSediment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS + <br /> AND O JP y <br /> ^ PRESERVATION $ $m 3 <br /> SAMPLE <br /> -*ofZ E: m z 1i o° NOTES ASSIGNED CONDITION <br /> 3 BOTTLE UPON <br /> DATE TIME SAMPLE ID m V 7 e .1 Z NUMBERS RECEIPT NOTES <br /> 2464 <br /> I'Z?3q-7 1215 ✓ GENARS <br /> 734 ✓ I ON ; <br /> "t1-3 1ISS i,J ,/ I MT <br /> NOTES 1 MISCELLAYEOU . RelinquisbC 1�-(Signature) d B ature) Date Time <br /> �-CAC� 4 Tre-S VJ f X03 Relinquished By (Signature) Received By (Sign e) ate Ti"Te <br /> UPOO LAS 1%Q_e%4AL <br /> QT Relinquished By (Signature) Received By (Signature) Date IIme <br /> Nkce 97 Oe)4/43 <br /> Method of Shipment Description of Other Chains-Of-Custody Dispatched By (Signature) Date Tinto Received for lab By (Signature) Date Time <br /> Transport Container Transported with this <br /> Chain (by Serial No) <br /> CO <br /> 0 12 ! LA-114 <br /> I IN <br /> Send Lab Results to (Name) IREWymA .) fel LF.t j (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER OTHER M-SW.Z Z� <br /> TEL(404)951-0055 TEL(303) 790-1747 TEL (714) 757-1755 TEL(415) 960-1640 TEL(219)926-8651 TELZQ9_29-ZZ7!!�'_ <br /> 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) 5561666 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 FAX (503) 2410486 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP • 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 • TELEPHONE (303) 290-8336 • FAX (303) 90-8013 <br /> SERIAL NO 18741 WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV 8192 <br />