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{ CANONIE ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LAB PROJ CT <br /> (See Reverse for Instructions) NO•T1 i O j('�l <br /> PROJECT NAME t f0�" `' SAMPLERS ry'�^ (-''`i -v/y,ta SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PRINT), DESCRIPTION CODES A. Ground water F. oil <br /> PROJECT NUMBER l?C' L� ' �t J� ������ 7C��— -A. 40-m1 VOA Vial B. Surface Water G. Waste 1. Standard <br /> (SIGN)--' B. Glass Liter E. Brass Tube C. Leachate 1. then Spike 2. 48 Hour <br /> U C. Plastic 500-m1 F.Other D. Rinseala 1. Other 3. 24 Hour <br /> RECORDER D. Plaslic Liter ri �1�)'- I-K� E. Soil/Sediment _- 4. Other----- <br /> (SIGN) <br /> ther —_-_(SIGN) _ <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND go W <br /> �— n— PRESERVATION F= y F � <br /> " x U g $Y m SAMPLE <br /> o Sm o -9 Q o et m <o NOTES ASSIGNED CONDITION <br /> € E€_ _ + N �- °v BOTTLE UPON <br /> DATE TIME SAMPLE ID Z NUMBERS RECEIPT NOTES <br /> lc<<f9T ( I Pp- ,al- <br /> v v ' <br /> ' Y k/ l — <br /> V V1 osT25-5L <br /> sal PA ;a3- is � k obrl (s-'s- r <br /> Itios P�- >g�I- 1 X <br /> O` <br /> f�rsl ter,- �3�►- _S• xkk' -- <br /> f <br /> - spZ-3o . 1_IOF IF t ISA NOTES/MISCELLANEOUS �'� F1 t ( .f UTA CAT"'1-4 UO t-)$ Relinquished by: (Signature) eRe <br /> By (Si ture Date Time <br /> r <br /> `ZZt,U ff,por 4 ��\ 1 c�xys t'nale �,�1� vc�� �5 Ml'{3E lJl �t ----Re <br /> einq �.� <br /> LT�E Relinq he B : (Si ure) =( ig ature) Date Time <br /> e k IV/t� Relinquished y: Ignature Received By: (Signature) Date Tim <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 Belo ) Vera�s Requested: Yes ❑ No 1" <br /> ❑ ATLANTA ❑ DENVER ❑ 'IRVINE ❑ MT VIEW ❑ PORTER OTHER <br /> TEL(404) 951-0055 TEL(303) 790-1747 TEL(714)757-1755 TEL(415)960-1640 TEL(219) 926-8651 TEL2�1 S� i Z 1 I <br /> FAX(404) 956-9364 FAX (303) 799-0186 FAX(714) 757-0960 FAX(415) 960-0739 FAX(219)926-7169 FAX 21 Z <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) 290-801 <br /> SERIAL NO. ` WHITE:Field Copy YELLOW:Project Copy PINK.Laboratory Copy RE'J 8/92 <br /> 1.4691. , <br />