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• rt <br /> Av <br /> ANONIE ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD SAB PROJECT <br /> (See Reverse for Instructions) No.9I 10 D_ <br /> f G � 1- _— <br /> PROJECT NAME 1 t aw�� �e J�`r SAMPLERS I ,t`^^ L,,AAR,("At' SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> 1 (PRINT] DESCRIPTION CODES A. Ground Water F. oil <br /> � . <br /> PROJECT NUMBERr 'I l)c l'5 �w. — A. 40 ml VOA Vial B. Surlace Water G. Waste 1. Standard <br /> A � ^T(SIG 2.B. Glass Liter E. Brass Tutt@'X11 C. Leachale H. BlanWSpika 48 dour <br /> RECORDER 11I�>N �l — r� C. Plastic 500-m1 F.Other=7 C_ D. Rinseale I. Other 3. 24 Hour <br /> (SIGN) y J D. Plastic Liter �Ly_.1.� j= E. SoillSediment q. Other <br /> NUMBER OF NALMSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND h `� <br /> €—g — PRESERVATION � a <br /> $ $ <br /> JA <br /> i Z �~ z <br /> SAMPLE0 If $ NOTES ASSIGNED CONDITION <br /> lie <br /> BOTTLE <br /> DATE TIME SAMPLE ID I- UPON <br /> _ <br /> � NUMBERS RECEIPT <br /> NOTES <br /> t S <br /> X 13 ac. X Y Q' C <br /> ",91- l,-J AF Y uIVI A V k oz -C -- <br /> Ia I `I 3>Enit.. u k ) - <br /> I`I3Z PtA- fly- 1rJ t� ) I N �' r_1l k y -r <br /> LJ tv Y SP,-C <br /> t — <br /> NOTES/MISCELLANEOUS ; a C w d �T5 Ov t{Q Relinquished by: (Signature) eoei ed B Tga, e / –da—le Time <br /> r�c,Ll 1.c,hiVc.�.v� {U �p}crt Itc.cl :Q�%iA '4 ,�t�o,rt' C.tA,y <br /> t L' 0 1 Reli ish d B . ( ignature) Received By: (Signature) Date Timeux lC.J( %P ,� ,.1 (\ v <br /> AA, e1 �R8c" , OldE TAME, T�8Ar &i9E <br /> do-1 In�1c� Q� I I)j ��jZX .I : l l c] Relinquished 8 (Signature) Received 8 (Signature) Date Time <br /> 9 y: f 9 ) y: ( 9 ) <br /> i <br /> Matho .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 /> rC Uv4, e ✓ <br /> Chain (by Serial No.) <br /> N!. <br /> vo <br /> Send Lab Results to (Name): 0t,) (Check Office Beloyv VJ bals Requested: Yes ❑ No <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT. VIEW ❑ PORTER E—OTHER i" A C '� <br /> TEL 1404) 951-0055 TEL(303) 790-1747 TEL(714) 757-1755 TEL(415)960-1640 TEL(219) 926-8651 TEL Tc`/ <br /> FAX(404) 956-9364 FAX (303) 799-0186 FAX(714) 757-0960 FAX (415)960-0739 FAX(219) 926-7169 FAX ZC.`r 5992 1 "t-5 <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 (303) 290-8336 • FAX (303) 290-8013 <br /> SERIAL NO. �� (� WHITE:Field Copy. YELLOW:Project Copy PINK:Laboratory Copy REV.8 <br /> 1 <br />