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6 <br /> CANONIE ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD B PROJECT <br /> (See Reverse for Instructions) NO t <br /> PROJECT NAME �_�� YQ�le; t 1J L,r �Tf]C Ts"IJ SAMPLERS A L,15- x �Wif&:5 SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PRINT} •--f� DESCRIPTION CODES A Ground Water F Oil <br /> PROJECT NUMBER q L1 -30-q 41-01 A� k- t-t,16)1� A 40-ml VOA Vial B Surface Water G Waste f Standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H Blank/Spike 2 48 Hour <br /> RECORDER C Plastic 500-mi F Other D Rmseate 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 <br /> `a AND g <br /> a. g PRESERVATION 8 <br /> g "Y v E I It SAMPLE <br /> it <br /> o ¢� Ei m° � NOTES ASSIGNED CONDITION <br /> J LL �' E > BOTTLE UPON <br /> DATE TIME SAMPLE ID z NUMBERS RECEIPT NOTES <br /> D22 q I1 d <br /> (UZSgZ lid M t <br /> Q 22A AI <br /> I <br /> NOTES MISCELLANEOUS S� Relinquished by (Signature) R eived sy (Signature) +4a �� rTlme <br /> L N l�e Gcor� tEr�PE#z-�t"�u 3. "B <br /> LRe }�'�.Q.-1 �AL Relinquished By (Signature) Received By Signature) Date Time <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 r� <br /> AgAO0 Chain (by Serial NO) <br /> Send Lab Results to (Name) -Tbkk 1,0-(T &tJ (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER OTHER &-106ES7`0 <br /> TEL (404)951-0055 TEL(303) 790-1747 TEL (7i4)757-1755 TEL(415)960-1640 TEL(219)926 8651 TEL - - Z1 <br /> FAX (404)956-9364 FAX(303) 799-0186 FAX(714)757-0960 FAX(415)960-0739 FAX(219)926 7169 FAX - - -ZZ 5- <br /> El <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) 2410486 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 1 /� R � /� WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV N2 <br /> ri r1 <br />