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r ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LAB PROJECT <br /> (See Reverse for Instructions) NO. <br /> PROJECT NAME TITTS SAMPLERS ALeX_ R0I04�? SAMPLE CONTAINER SAMPLE DESCRIPTION CODES T ODES <br /> C (PRINT) DESCRIPTION CODES A. Ground Water F. Oil t! <br /> PROJECT NUMBER q0 9 5`E + 0003 A. 40-m1 VOA Vial B. Surface Water G. Waste 1. Standard 7 d°` <br /> (SIGN) B. Glass Liter E. Brass�u�e C. Leachate H. Blank/Spike 48Hc++ <br /> RECORDER C. Plastic 500-ml F.Other `s D. Rinseate I. Other 3. 24 Hour <br /> (SIGN) D. Plastic Liter E. Soil/Sediment .. 4. Other--_ <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS 0 <br /> AND $ Y <br /> PRESERVATION <br /> aag ogg SAMPLE <br /> ao NOTES ASSIGNED CONDITION <br /> a °V BOTTLE UPON <br /> DATE TIME SAMPLE ID 1z NUMBERS RECEIPT NOTES <br /> ►WIT7 F A 111 V c4a <br /> NOTES/MISCELLANEOUS Relinquished by: (Signature) R d By: Si cure) Date Time <br /> LA3: AEt� ` E�EP"PT oNu( <br /> '(gR,rv►T3E, D 1 p E ET[ - Relinquished By: (Signature) eceived By: (Signal ate Time <br /> C"XIE"emk-1.15s - JEI- PrDDtTI✓f � <br /> Relinquished By: (Signature) Received 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 /> AN Ctio2iEe Chain (by Serial No.) <br /> CA©t��. 14 tog b t 140 015 <br /> Send Lab Results to (Name): VJ AO ► LLE-d (Check Office Below) Verbals Requested: Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER r ❑ IRVINE ❑ MT. VIEW ❑ PORTER EBzarHER MODEST?) <br /> TEL(404) 951-0055 TEL(303) 790-1747 TEL(714) 757-1755 TEL(415)960-1640 TEL(219) 926-8651 <br /> FAX (404)956-9364 FAX(303) 799-0186 FAX (714)757-0960 FAX(415)960-0739 FAX(219) 926-7169 FAX 2.(fl-_J_Z�20;� <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 /> 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 8192 <br />