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CANONIE ENVIRONMENTA HAIN-OF-CUSTODY RECORD r s PROJECT <br /> (� (See er Instructions) <br /> PROJECT NAM aW,60 Jli kV4 N-37SAMPLER AL Jx tZ�S SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> X37 (PRINT) DESCRIPTION CODES A Oround water F OilPROJECT NUMBER ` A. 40-MI VOA VIaI a Burleoe Water O waste 1 Standard <br /> EON) s plass Uer E Brass Tube c Leachale H Blank/Splka 2 4e Hour <br /> RECORDER C Plastic 500 ad F Olher 1) Rkueate I Olher 3 24 Hour <br /> (SIGH) D Plastic LIIer E SMI/Sedlment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAIr4EFIS <br /> AND a <br /> PRESERIW N h <br /> = SAMPLE <br /> v ` -r NOTES ASSIGNED CONDITION <br /> DATE TIME SAMPLE ID BOTTLE UPONNUMBERS RECEIPT NOTES <br /> fool A .V1 V W ✓ IV DAY v <br /> 042K <br /> la <br /> one 1 01 <br /> ( ru <br /> NOTES l MISCELLANEOUS ❑ /JP,� elinqulsh ature) Re elved By ( tgnat e) Date TI <br /> m <br /> D , " PEAU L° '1 - <br /> r P Relinquished By (Signature) Received By (Signature) Date Tlm <br /> ARR I VA4. e <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> Method of Shipment Description of Other Chalns-Of-Cuslody Dispatched By (Signature) Date Time Received for lab By (Signature) Date Time <br /> Transport Contalner Transported with this <br /> Chain(by Serial No) r—�~ <br /> Www rs ' '- C0 --A&,b / 16za <br /> Send Lab Results to (Name) 10A1 7T6pl47 (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER VOTHER <br /> TEL(404)951-0055 TEL(303)790-1747 TEL(714)757.1755 TEL(415)960-1640 1TEL(219)8268651 TEL <br /> ,FAX(404)956-9364 FAX(303) 799-0186 FAX(714)757-0960 FAX(415) 960.0739 FAX(219)926.71169 FAX <br /> ❑ 4BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON 11PORTLAND ❑ OTHER <br /> EL(406)5869496 TEL(713)566-1666 TEL(215)337-2551 TEL(510)463.9117 TEL(603) 2410282 TEL <br /> FAX(406)588.9724 FAX(713)556-0668 FAX(215)337.0560 FAX(510)463.2981 FAX(503)241-0488 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP— )3300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 a TELEPHONE 303 290-13336 a FAX 303 290 8013 <br /> SERIAL 140 15 <br /> 5 5 <br /> J WRITE Field Copy YELLOW Prolecl Copy PINK Laboratory Copy REV M2 <br />