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i <br /> CANONIE ENVIRONMENTAL AIN-OF-CUS�DY RECORD B PROJECT <br /> (See Reverse r Instructions) N <br /> PROJECT NAME ��SKS- �ce��+sem_ SAMPLERS Ior+... L� e+crrQ..v. SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PTJ DESCRIPTION CODES A Ground Water F Oct 1 <br /> PROJECT NUMBER M-7111 C) I O, A 40-m1 VOA Vial ' B Surface water G waste t Standard , <br /> (SIG ) B Glass Liter E Brass Tube C Leachate H BlanklSplke _ 2 48 Hour <br /> RECORDER C Plastic 6Mml F Other D Ru,seate I Other 3 24 Hour�- <br /> D Plastic Liter E Soll/Sedtment 4 Other <br /> (SIGN) ' r <br /> NUMBER OF NALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS e AND s —17 D <br /> %- PRESERVAHON Y ` .1 V 0 't a <br /> 38 g _J 40 ¢r, 9t 119 ME SAMPLE <br /> r F s �'_ NOTES ASSIGNED CONDITION <br /> "T � 7BOTTLE UPONDATE TIME SAMPLE ID N $ NUMBERS RECEIPT NOTES <br /> o F1' - - .S ?E ) <br /> F�- — .S <br /> �_� _ i S7 ,5 <br /> � _ Y <br /> - i , e <br /> , <br /> 10- F 1 "" �VLD <br /> 7-V 15 <br /> 7A -SCS T <br /> -6(5 _ZS S' 12, <br /> NOTES!MISCELLANEOUS s - Relinquished by (Signature) R ed By S ature) r� /Date Time <br /> 3 {�� ►�� 9-)q l Uo USS:. L.a+r Mfl L S <br /> l� I� ` f � v ' v 4 c TE <br /> 0 Relinquished By-(Signature) Received By (Sign re) !' Date Time <br /> Relinquished By (Signature) Received By (Signature)- 7= L Date Time <br /> Ntt7 - d,Q5.0fNtokw O,i �W�,L 5 I 5I _ a i - , <br /> Method of Shipment Description of Other Chains-Of-Custody Dispatched By (Signature) Date Tame Received for lab By (Signature) Date Time' <br /> �L Transport Container Transported With this r <br /> G� Chain (by Serial No) <br /> i J <br /> 1 C ; <br /> ��.� r, ✓ C olo �Lr 't 11461f l <br /> i, Send Lab Result`s to (Name) 3s�-.,z_ Vo,:r. r .�. (Check Office Below) Verbais Requested Yes ❑ No <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER ' s OTHER ;= <br /> TEL(404)9510055 TEL(303) 790-1747 TEL(714) 757-1755 TEL(415)960-1640 TEL(219)926-8651 TELA S Q-ZZZ 1 <br /> FAX(404)956-9364 FAX(303) 799-0186 FAX(714) 757-0960 FAX (415)960-0739 FAX(219)926-7169 " FAX `i r <br /> ❑ BOZEMAN ❑ HOUSTON = ❑ KING OF PRUSSIA ❑ PLEASANTON t' ❑-PORTLAND ', { ` ❑ OTHER <br /> TEL(406) 586-9496 TEL(713)556- 6$6,, w TEL(215) 337-2551 1` } TEL(510)463-9167 t TEL(503) 241-0282 `w ,7� TELA <br /> FAX (406) 586-9724 FAX(713) 556-0666FAX(215)337-0560 FAX(510)463-2981 FAX'(503) 241-0486 z FAX 11 u <br /> GAME ENVI RON ME14TALj$ERV1CES, CORP • 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 • TELEPHONE 303 290-8336 • FAX 303 290-8013 <br /> SERIAL NO6 f- w WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV 8192 <br />